脑小血管病患者的认知控制容量研究

Capacity of cognitive control in patients with cerebral small vessel disease

目的评估脑小血管病(cerebral small vessel disease,CSVD)患者是否存在认知控制容量(capacity of cognitive control,CCC)的改变,以及CSVD患者认知控制容量与其他认知功能损害的关系,评估CCC预测CSVD发生的价值。方法共纳入21例符合条件的CSVD患者和22例正常对照,采用多数刺激掩蔽任务(the majority function task-masked,MFT-M)测量认知控制容量,同时进行蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)、言语流畅性测试(verbal fluency test,VFT)、中文听觉词汇学习测试(Chinese auditory verbal learning test,CAVLT)、符号数字模式测验(symbol digit modalities test,SDMT)、数字广度(digital span,DS)、Stroop色词测验(Stroop color word test,SCWT)、彩色数字连线测验(color trail test,CTT)和修订版波士顿命名测验(modified Boston naming test,Modified BNT)。比较CSVD组和对照组各项认知功能,在CSVD患者中分析CCC与其他认知功能的相关性。应用Logistic回归分析评估CCC对CSVD发生的预测作用。结果CSVD组CCC低于正常对照组[(2.97±0.72)bps,(3.53±0.62)bps,t=-2.704,P=0.01]。CSVD组和正常对照组在MoCA[(22.24±4.58)分,(24.86±2.42)分,t=-2.334,P=0.026]、VFT-动物[12(6)分,15(6)分,Z=-2.965,P=0.003]、VFT-蔬菜水果[(13.79±3.81)分,(18.27±4.13)分,t=-3.592,P=0.001]、CAVLT-瞬时回忆[(7.45±2.18)分,(9.11±2.08)分,t=-2.502,P=0.017]、CAVLT-短时延迟[(7.20±3.32)分,(10.76±3.08)分,t=-3.564,P=0.001]、CAVLT-长时延迟[(7.30±3.16)分,(10.29±3.18)分,t=-3.012,P=0.005]、SDMT[(15.95±5.49)分,(23.41±12.73)分,t=-2.513,P=0.018]、CTT-A[85.17(42.60)分,55.50(52.65)分,Z=-2.965,P=0.003]、CTT-B[(200.69±71.35)分,(132.44±53.66)分,t=3.556,P=0.001]、CTT干扰指数[(104.13±53.31)分,(65.20±35.98)分,t=2.819,P=0.007]评分的组间差异具有统计学意义;但在VFT-水开头词语[(3.68±2.63)分,(5.44±2.71)分,t=-1.940,P=0.061]、CAVLT-再认[14(3)分,14(4)分,Z=-0.524,P=0.601]、DS-正序[7.0(3.0)分,5.5(2.0)分,Z=-0.152,P=0.880]、DS-倒序[4(1)分,4(2)分,Z=-1.044,P=0.297]、SCWT干扰指数[(9.50±9.28)分,(5.94±10.47)分,t=1.123,P=0.268]、Modified BNT[14(3)分,13.5(3)分,Z=-0.727,P=0.467]差异无统计学意义。CSVD患者CCC与MoCA评分之间存在显著正相关关系(r=0.551,P=0.010)。CSVD患者CCC与DS-正序(r=0.532,P=0.013)、SCWT干扰指数(r=-0.487,P=0.040)之间也存在显著相关关系。Logistic回归分析结果表明,认知控制容量可以预测CSVD的发生[B=-1.318,P=0.019,OR=0.268,95%CI(0.089~0.808)]。结论CSVD患者的认知控制容量较正常人显著下降,CSVD患者的认知控制容量与整体认知显著相关。CCC与CSVD的发生有密切关系,CCC可以预测CSVD的发生。

Objective To evaluate the capacity of cognitive control(CCC)in patients with cerebral small vessel disease(CSVD)and explore the relationship between CCC and cognitive function in CSVD,and to assess the predict value of CCC on the occurrence of CSVD.Methods Twenty-two patients with CSVD and twenty-three healthy controls were enrolled.All of them completed the majority function task-masked(MFT-M)and a set of neuropsychological tests.Neuropsychological test was performed by Montreal cognitive assessment(MoCA),verbal fluency test(VFT),Chinese auditory learning test(CAVLT),symbol digit modalities test(SDMT),digital span(DS),Stroop color word test(SCWT),color trail test(CTT)and Modified Boston naming test(Modified BNT).The predict value of CCC for the occurrence of CSVD was assessed with logistic regression analysis.Results CCC of patients with CSVD was lower than that of healthy control((2.97±0.72)bps vs(3.53±0.62)bps,t=-2.704,P=0.01).Between patients with CSVD and healthy control,there were significant differences in MoCA((22.24±4.58 vs(24.86±2.42),t=-2.334,P=0.026),VFT-animal(12(6)vs 15(6),Z=-2.965,P=0.003),VFT-vegetables and fruits((13.79±3.81)vs(18.27±4.13),t=-3.592,P=0.001),CAVLT-immediate((7.45±2.18)vs(9.11±2.08),t=-2.502,P=0.017),CAVLT-short term delay((7.20±3.32)vs(10.76±3.08),t=-3.564,P=0.001),CAVLT-long term delay((7.30±3.16)vs(10.29±3.18),t=-3.012,P=0.005),SDMT((15.95±5.49)vs(23.41±12.73),t=-2.513,P=0.018),CTT-A(85.17(42.60)vs 55.50(52.65),Z=-2.965,P=0.003),CTT-B((200.69±71.35)vs(132.44±53.66),t=3.556,P=0.001),and CTT-B-A((104.13±53.31)vs(65.20±35.98),t=2.819,P=0.007).But there was no significant difference in VFT-word begin with Chinese character"water"((3.68±2.63)vs(5.44±2.71),t=-1.940,P=0.061),CAVLT-recognition(14(3)vs 14(4),Z=-0.524,P=0.601),DS-forward(7.0(3.0)vs 5.5(2.0),Z=-0.152,P=0.880),DS-backward(4(1)vs 4(2),Z=-1.044,P=0.297),SCWT((9.50±9.28)vs(5.94±10.47),t=1.123,P=0.268),Modified BNT(14.0(3.0)vs 13.5(3.0),Z=-0.727,P=0.467)between CSVD patients and healthy controls.In patients with CSVD,CCC was positively correlated with scores of MoCA(r=0.551,P=0.010)and also with DS-forward(r=0.532,P=0.013)and SCWT(r=-0.487,P=0.040).Logistic regression analysis showed that CCC was an important variable in predicting the possibility of CSVD(B=-1.318,P=0.019,OR=0.268,95%CI(0.089-0.808)).Conclusion Compared with the healthy control,CCC in patients with CSVD decreases significantly and CCC is related to the cognitive impairment.CCC can predict the possibility of CSVD.