急性小脑梗死患者认知功能变化及其与大脑结构网络的相关性研究

Cognitive function changes and its correlation with brain structure network in patients with acute cerebellar infarction

目的研究急性小脑梗死患者认知功能评估及其与大脑结构网络的相关性。方法回顾性分析2021年10月至2022年10月沧州市人民医院收治入院的45例急性小脑梗死患者临床资料,将其设为观察组,选取同一时期入院的45名健康体检者设为对照组。两组研究对象均进行认知功能评估,评估方法为神经认知和行为学检测[Berg平衡量表(BBS)、画钟测试(CDT)、波士顿命名测试(BNT)、连线测验(TMT)-A、TMT-B、数字广度测试(DST)、听觉词语学习测试(RAVLT)、蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)],弥散张量成像数据通过磁共振成像(MRI)扫描检查获取,大脑结构网络拓扑特征参数[小世界特性(σ)、标准化特征路径长度(λ)、标准化聚类系数(γ)、全局效率(Eglob)、局部效率(Eloc)、最短路径长度(Lp)、聚类系数(Cp)]通过确定性纤维追踪算法、图形理论获取。比较两组研究对象的一般资料及大脑结构网络拓扑特征参数,用相关性分析方法评估急性小脑梗死患者认知功能与大脑结构网络拓扑特征参数的关系。结果观察组患者TMT-A、TMT-B用时长于对照组,BBS评分、CDT评分、DST评分、RAVLT评分、MoCA评分、MMSE评分均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者的Lp、Cp水平明显高于对照组,Eloc、Eglob水平均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者14个脑区[左侧三角部额下回(IFGtriang)、左侧、右侧后扣带回(PCG)、左侧顶下缘角回(IPL)、左侧颞极颞中回(TPOmid)、左侧颞极颞上回(TPOsup)、左侧眶部额下回(ORBinf)、左侧、右侧的楔前叶(PCUN)、左侧、右侧的补充运动区(SMA)、左侧岛盖部额下回(IFGoperc)、左侧、右侧的内侧和旁扣带脑回(DCG)]的区域效率明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者的网络Lp与MoCA评分呈负相关(P<0.05),右侧PCG区域效率、左侧DCG区域效率、右侧DCG区域效率、Eglob与MoCA评分均呈正相关(P<0.05)。观察组患者的Lp与TMT-B用时呈正相关(P<0.05),左侧DCG区域效率、右侧PCUNG区域效率、右侧DCG区域效率与TMT-B用时均呈负相关(P<0.05)。观察组患者左侧DCG区域效率与TMT-A用时呈负相关(P<0.05),Eglob与RAVLT评分呈正相关(P<0.05)。结论急性小脑梗死患者存在注意力认知障碍、视空间障碍、执行能力障碍及记忆功能障碍,额颞叶与双侧DCG、PCG、PCUN信息传递效率处于持续性下降状态,且认知功能障碍发生过程中右侧PCUN、双侧DCG及右侧PCG异常起着重要作用。

Objective To study the correlation between cognitive function assessment and brain structural network in patients with acute cerebellar infarction.Methods The study method was retrospective analysis.The observation subjects were 45 patients with acute cerebellar infarction admitted to Cangzhou People's Hospital from October 2021 to October 2022,and they were set as the study group.Forty-five healthy patients admitted to hospital during the same period were selected as the control group.The cognitive function of both groups was evaluated by neurocognitive and behavioral tests.The data of diffusion tensor imaging(DTI)were obtained by magnetic resonance imaging(MRI),and the topological parameters of brain structure network were obtained by deterministic fiber tracking algorithm and graph theory[Berg balance scale(BBS),clock drawing test(CDT),Boston naming test(BNT),trail making test(TMT)-A,TMT-B,digital breadth test(DST),rey auditory verb learning test(RAVLT),Montreal cognitive assessment scale(MoCA),mini-mental state examination(MMSE)].The diffusion tensor imaging data was obtained through magnetic resonance imaging(MRI)scanning,and the topological feature parameters of the brain structure network[small world characteristics(σ),standardized feature path length(λ),standardized clustering coefficient(γ),the global efficiency(Eglob),local efficiency(Eloc),shortest path length(Lp),and clustering coefficient(Cp)]were obtained through deterministic fiber tracking algorithms and graph theory.The general data and brain structure network topology parameters were compared between the two groups,the correlation analysis method was selected to evaluate the relationship between cognitive function and brain structure network topology parameters in patients with acute cerebellar infarction.Results TMT-A and TMT B took longer in the study group than in the control group,BBS score,CDT score,DST score,RAVLT score,MoCA score and MMSE score were lower than control group,and the differences were statistically significant(P<0.05).The shortest path length(Lp)and clustering coefficient(Cp)of the study group were higher than those of the control group,but the local efficiency(Eloc)and global efficiency of brain network(Eglob)of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).In the study group,the regional efficiency of 14 brain regions[left triangular inferior frontal gyrus(IFGtriang),left and right posterior cingulate gyrus(PCG),left parietal inferior marginal angular gyrus(IPL),left temporal polar-temporal middle gyrus(TPOmid),left temporal polar-temporal superior gyrus(TPOsup),left orbital inferior frontal gyrus(ORBinf),left and right anterior cuneate lobe(PCUN),left and right supplementary motor area(SMA),left inferior frontal gyrus of insular operc(IFGoperc),left medial and paracingulate gyrus of left and right(DCG)]was lower than that in the control group,and the differences were statistically significant(P<0.05).In the study group,the network Lp was negatively correlated with the MoCA score(P<0.05),and the right PCG regional efficiency,left DCG regional efficiency,right DCG regional efficiency,Eglob was positively correlated with the MoCA score(P<0.05).In the study group,there was a positive correlation between Lp and TPT-B time(P<0.05),and a negative correlation between left DCG region efficiency,right PCUNG region efficiency and right DCG region efficiency and TPT-B time(P<0.05).In the study group,the efficiency of left DCG region was negatively correlated with the time of MTT-A(P<0.05),and Eglob was positively correlated with RAVLT score(P<0.05).Conclusion Patients with acute cerebellar infarction have attention cognitive impairment,visuospatial impairment,executive ability impairment and memory dysfunction.The information transmission efficiency of frontotemporal lobe and bilateral DCG,PCG,and PCUN is in a state of continuous decline,and abnormalities of right PCUN,bilateral DCG,and right PCG play an important role in the occurrence of cognitive dysfunction.