老年脑小血管病患者数字化画钟测试的表现特征

Characteristics of digital clock drawing test in elderly cerebral small vessel disease patients

目的研究老年脑小血管病患者数字化画钟测试(digital clock drawing test,dCDT)的表现特征。方法选择老年患者40例,根据Fazekas量表评分分为重度脑白质损害(HBSVD,2~3分)组20例和对照组(≤1分)20例。记录dCDT参数:传统画钟测试(tCDT)、思考时间、完成总时间、落笔压力。采用选择反应时间测试(CRT)反映注意力,1min动物语义性词语流畅性测验(VFT)反映语言功能,数字图形转换(DSST)检测执行功能和处理速度,连线测验B(TMT-B)检测认知灵活性。结果2组tCDT和完成总时间比较,差异无统计学意义(P>0.05)。HBSVD组CRT、TMT-B及思考时间明显高于对照组[(572.25±125.53)ms vs(480.00±85.78)ms,P=0.013;(89.30±28.98)s vs(69.85±19.67)s,P=0.018;(68.90±8.34)%vs(61.95±7.91)%,P=0.010]DSST及落笔压力明显低于对照组,差异有统计学意义[(18.75±24.40)个vs(24.40±9.34)个,P=0.040;368.45±108.48 vs 456.90±150.33,P=0.039]。线性回归分析显示,在调整年龄、性别、受教育程度、血管性危险因素及其他影像学表现后,完成画钟过程中思考时间与CRT呈正相关(β=0.368,P=0.018),与DSST呈负相关(β=-0.426,P=0.006);落笔压力与CRT、VFT、DSST、TMT-B无显著相关性(P>0.05)。结论与tCDT不同,老年脑小血管病患者存在的认知功能损害可以被dCDT检出。

Objective To study the characteristics of digital clock drawing test(dCDT)in elderly cerebral small vessel disease(SVD)patients.Methods Forty elderly patients who visited our hospital from April 2019to September 2019were divided into severe white matter lesion group(n=20)and control group(n=20)according to their Fazekas scale score.The dCDT parameters were recorded,including traditional CDT(tCDT)score,thinking time,total CDT fulfilling time and handwriting pressure.The attention of patients was tested by choice reaction test(CRT),the language performance of patients was tested by 1min verbal fluency test(VFT),the executive performance of patients was tested by digit symbol substitution test(DSST)and the cognitive flexibility of patients was tested by trail making test-B(TMT-B).Results No significant difference was detected in tCDT score and total CDT fulfilling time between the two groups(P>0.05).The CRT time,TMT-B time and thinking time were significantly longer while the DSST score and handwriting pressure were significantly lower in severe white matter lesion group than in ontrol group(572.25±125.53ms vs 480.00±85.78ms,P=0.013;89.30±28.98svs 69.85±19.67s,P=0.018;68.90%±8.34%vs 61.95%±7.91%,P=0.010;18.75±24.40 vs24.40±9.34,P=0.040,368.45±108.48 vs 456.90±150.33,P=0.039).Linear regression analysis showed that the thinking time was positively related the CRT time and negatively related with the DSST time(β=0.368,P=0.018,β=-0.426,P=0.006)after adjustment of age,gender,educational level,vascular risk factors and other imaging parameters.However,the handwriting pressure was not significantly related with the CRT time,VFT time,DSST time,TMT-B time(P>0.05).Conclusion Cognitive impairment in elderly cerebral SVD patients can be detected by dCDT but not tCDT.