急性小脑梗死患者认知功能评估及其与大脑结构网络的关系研究

Relation of cognitive function assessment with brain structure network in patients with acute cerebellar infarction

目的探讨急性小脑梗死患者认知功能的改变及其与大脑结构网络的关系。方法选择南京医科大学附属脑科医院神经内科自2016年7月至2019年10月收治的36例小脑后叶梗死患者作为小脑梗死组;选择同期门诊体检以及年龄、性别和受教育年限与小脑梗死组患者相匹配的30例健康对照者作为对照组。对2组受试者进行神经认知和行为学测试以评估其认知功能以及进行MRI扫描获得弥散张量成像(DTI)数据,并采用确定性纤维追踪算法以及图形理论获得受试者大脑结构网络拓扑特征参数。比较2组间临床资料、大脑结构网络拓扑特征参数的差异,并采用相关性分析评估小脑梗死组患者大脑结构网络拓扑特征参数与认知功能的相关性。结果与对照组比较,小脑梗死组患者的简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分降低,听觉词语学习测试(RAVLT)、数字广度测试(DST)、画钟测试(CDT)评分及Berg平衡量表(BBS)评分均降低,连线测验(TMT)-A、TMT-B用时增加,差异均有统计学意义(P<0.05)。与对照组比较,小脑梗死组患者脑网络全局效率(Eglob)和局部效率(Eloc)降低,聚类系数(Cp)和最短路径长度(Lp)增加,差异均有统计学意义(P<0.05)。与对照组比较,小脑梗死组患者14个脑区[左侧、右侧的内侧和旁扣带脑回(DCG),左侧岛盖部额下回(IFGoperc),左侧、右侧的补充运动区(SMA),左侧、右侧的楔前叶(PCUN),左侧眶部额下回(ORBinf),左侧颞极颞上回(TPOsup),左侧颞极颞中回(TPOmid),左侧顶下缘角回(IPL),左侧、右侧后扣带回(PCG),左侧三角部额下回(IFGtriang)]的区域效率降低,差异均有统计学意义(P<0.05)。小脑梗死组患者的MoCA评分与脑网络Lp呈负相关关系(P<0.05),与Eglob及右侧DCG、左侧DCG、右侧PCG区域效率均呈正相关关系(P<0.05);小脑梗死组患者的RAVLT评分与Eglob呈正相关关系(P<0.05),TMT-A用时与左侧DCG区域效率呈负相关关系(P<0.05);TMT-B用时与右侧DCG、右侧PCUN、左侧DCG区域效率呈负相关关系(P<0.05),但是与Lp呈正相关关系(P<0.05)。结论急性小脑梗死患者存在记忆、执行能力、视空间及注意力认知障碍,同时双侧PCUN、PCG、DCG和额颞叶信息传递效率降低,其中右侧PCG、双侧DCG以及右侧PCUN的异常改变可能在其认知功能障碍的形成中起关键作用。

Objective To explore the relations of changes in the cognitive function with brain structure network in patients with cerebellar infarction.Methods Thirty-six patients with cerebellar infarction at the posterior lobe,admitted to our hospital from July 2016 to October 2019,were chosen as cerebellar infarction group;and 30 healthy subjects matched with age,gender,and education level at the same time period were used as control group.Neurocognitive and behavioral tests were performed on both groups to assess the cognitive functions,and MR imaging was performed to obtain diffusion tensor imaging(DTI)data.Deterministic tractography and graph theory were used to obtain the structural brain network and network parameters of all subjects.The differences of clinical data and brain network topological characteristic parameters between the two groups were compared,and the correlation between the subjects'brain structural network characteristic parameters and cognitive function was analyzed.Results As compared with the control group,patients in the cerebellar infarction group had significantly lower Mini-mental State Examination(MMSE),Montreal Cognitive Scale(MoCA),Rey Auditory Verbal Learning Test(RAVLT),Digit Span Test(DST),Clock Drawing Test(CDT)and Berg Balance Scale(BBS)scores,and significantly longer Trail Making Test(TMT)time-consuming(P<0.05).As compared with the control group,the cerebellar infarction group showed significantly decreased global efficiency(Eglob)and local efficiency(Eloc)in the brain network,and significantly increased clustering coefficient(Cp)and length of path(Lp,P<0.05).As compared with the control group,the cerebellar infarction group had significantly reduced nodal efficiency in 14 brain regions(P<0.05),including bilateral median cingulate and paracingulate gyri(DCG),left inferior frontal gyrus-opercular part(IFGoperc),bilateral supplementary motor area(SMA),bilateral precuneus(PCUN),left inferior frontal gyrus-orbital part(ORBinf),left temporal pole-superior temporal gyrus(TPOsup),left temporal pole-middle temporal gyrus(TPOmid),left inferior parietal-supramarginal and angular gyri(IPL),bilateral posterior cingulate gyrus(PCG),left inferior frontal gyrus-triangular part(IFGtriang).MoCA scores were significantly negatively correlated with Lp(r=-0.388,P=0.019),and were significantly positively correlated with Eglob(r=0.350,P=0.036),and efficiencies in the right DCG(r=0.428,P=0.009),left DCG(r=0.359,P=0.031)and right PCG(r=0.350,P=0.037)in the cerebellar infarction patients.The RAVLT scores showed a significantly positive correlation with Eglob(r=0.338,P=0.044).The TMT-A time-consuming and left DCG had significant negative correlation(r=0.357,P=0.032).TMT-B time-consuming was significantly negatively correlated with right DCG(r=-0.432,P=0.008),right PCUN(r=-0.350,P=0.036)and left DCG(r=-0.398,P=0.016),and positively correlated with Lp(r=0.406,P=0.014).Conclusions There is cognitive dysfunction in multiple domains after acute cerebellar infarction,including memory,executive function,visuospatial ability and attention.At the same time,there are reduced efficiency of information transmission in bilateral PCUN,PCG and DCG,and the frontal temporal lobe;among them,the abnormal changes of the right PCG,bilateral DCG,and right PCUN may play key roles in cognitive dysfunction.