脑白质高信号和多发性腔隙性梗死的步态障碍特点及其与认知功能的相关性研究

Characteristics of gait disorder of white matter hyperintensity and multiple lacunar infarction and its correlation with cognitive function

目的研究脑白质高信号(WMH)和多发性腔隙性梗死(LI)的步态障碍特点及其与认知功能的相关性。方法选取本院神经内科门诊及住院的31例可能源于血管因素的WMH患者为WMH组,28例多发性LI患者为LI组,另选取性别、年龄匹配的健康人26例为NC组。采用多种量表评估总体认知功能及情绪障碍;通过TUG试验、Berg平衡量表(BBS)测评步态的移动性及稳定性;采用IDEEA记录仪记录步态参数。比较三组的认知功能与步态参数,对WMH组和LI组患者的步态特点与认知功能的关系进行相关性分析。结果WMH组和LI组的总体认知功能评分均低于NC组(P<0.05);WMH组的定向、记忆、注意、执行、计算评分均低于NC组(P<0.05);LI组的记忆、执行评分低于NC组(P<0.05);WMH组的定向、记忆、计算评分均低于LI组(P<0.05)。WMH组较NC组TUG试验时间显著延长,平衡功能下降,步长缩短,步速减慢,步频减少(P<0.05);LI组较NC组TUG试验时间显著延长,平衡功能下降(P<0.05),步长、步速、步频无显著差异(P>0.05);与LI组相比,WMH组步长缩短,步速下降更明显(P<0.01)。WMH组中,步长与执行功能呈显著正相关(P=0.025);LI组中,步长与注意功能呈显著正相关(P=0.012)。结论WMH影响步态的移动性和稳定性,LI主要影响步态的稳定性;WMH步态障碍与执行功能受损有关,LI步态障碍与注意功能受损有关。

Objective To study the characteristics of gait disorder of white matter hyperintensity(WMH)and multiple lacunar infarction(LI)and its correlation with cognitive function.Methods A total of 31 outpatients and inpatients with WMH of presumed vascular origin in neurology department of our hospital were selected as WMH group,28 patients with multiple LI were selected as LI group,and 26 healthy people matched by gender and age were selected as NC group.Multiple scales were used to evaluate the overall cognitive function and emotional disorders;TUG test and Berg balance scale(BBS)were used to evaluate gait mobility and stability;IDEEA recorder was used to record gait parameters.The cognitive function and gait parameters of the three groups were compared,and the relationship between gait characteristics and cognitive function of patients in the WMH group and the LI group was analyzed.Results The overall cognitive function scores of the WMH group and the LI group were lower than that of the NC group(P<0.05).The scores of orientation,memory,attention,execution and calculation in the WMH group were lower than those in the NC group(P<0.05);the scores of memory and execution in the LI group were lower than those in the NC group(P<0.05);the scores of orientation,memory and calculation in the WMH group were lower than those in the LI group(P<0.05).Compared with the NC group,the time of TUG test in the WMH group was significantly longer,balance function decreased,step length shortened,step speed slowed down,and step frequency reduced(P<0.05);compared with the NC group,the time of TUG test in the LI group was significantly longer,balance function decreased(P<0.05),and there were no significant differences in step length,step speed and step frequency(P>0.05);compared with the LI group,step length in the WMH group shortened,step speed decreased more significantly(P<0.01).In the WMH group,step length was significantly positively correlated with executive function(P=0.025);in the LI group,step length was significantly positively correlated with attention function(P=0.012).Conclusion WMH affects the mobility and stability of the gait,LI mainly affects the stability of the gait;gait disorder of WMH is related to impaired executive function;gait disorder of LI is related to impaired attention function.