轻度认知功能损害的血管危险因素和认知损害  

Vascular risk factors and cognitive impairment in patients with mild cognitive impairment

作　　者：孙中武[1] 朱小群[1] 周江宁[2] 

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022 [2]中国科学技术大学生命科学院,合肥230022

出　　处：《安徽医科大学学报》2007年第3期313-316,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省教育厅自然科学基金资助课题(编号:2004kj197)

摘　　要：目的探讨轻度认知功能损害(MCI)两种主要亚型的血管危险因素和认知损害特征。方法采用多种神经心理学量表对43例MCI和30名年龄、性别和受教育程度与之相匹配的认知正常老年对照组进行评定;按照诊断标准确定27例为遗忘型MCI(MCI-A),16例为血管型MCI(MCI-V);比较MCI-A、MCI-V和对照组的血管危险因素和认知损害特征。结果MCI-V收缩压较MCI-A显著升高(P<0·05),其高血压患病率和吸烟率较对照组显著升高(分别为P<0·05,P<0·01)。MCI-A和MCI-V整体认知功能评分均较对照组有显著性降低(P<0·001);MCI-A的认知损害主要表现在记忆、语言、注意、知觉、定向、运用等方面(P<0·05～0·001),MCI-V更多在语言、运用、记忆、知觉等方面受损(P<0·05～0·01);MCI-A的逻辑记忆较对照组显著降低(P<0·01～0·001),MCI-V与对照组无差异。MCI-A和MCI-V画钟试验评分(CDT)均较对照组为差(P<0·05);MCI-V中Hachinski缺血评分(HIS)较MCI-A和对照组均显著升高(P<0·001)。3组间抑郁评分无差异。结论MCI-V常见危险因素为高血压病和吸烟。两种主要MCI亚型均表现为多区域认知损伤,MCI-A的逻辑记忆损害较为突出。CDT可有效识别MCI,适用于MCI的早期诊断,HIS可帮助鉴别两种不同MCI亚型。Objective To investigate the characteristics of vascular risk factors （VRFs） and cognitive impairment in two subtypes of mild cognitive impairment （MCI）. Methods Forty-three MCI and 30 cognitively normal older individuals were assessed using multiple neuropsychological tests. Twenty-seven amnestic type-MCI（MCI-A） and 16 vascular type-MCI （MCI-V） were determined and classified according to the diagnostic criteria. Data from VRFs and cognitive impairment were analyzed. Results Compared with MCI-A, MCI-V showed significant increases in the systolic blood pressure（ P 〈 0. 05 ）. The prevalence of hypertension and smoking in MCI-V were markedly higher than those in controls（ P 〈 0. 05, P 〈 0. 01 respectively）. There were significant decreases of overall cognitive function in patients with MCI-V and MCI-A compared with controls（P 〈0. 001 ）. Memory, language,attention,perception,orientation and praxis were impaired in MCI-A （P 〈0. 05 -0. 001 ）, while language,praxis, memory and perception were impaired in MCI-V （ P 〈 0. 05 - 0. 01 ）. The poorer performance in the tests evaluating logical memory were showed in the MCI-A（P 〈0. 05）,not in MCI-V. Both MCI-A and MCI-V showed significant decreases in the clock drawing test （CDT） compared with controls （ P 〈 0. 05 ）. Hachinski ischemic score （HIS） in MCI-V increased more than those in MCI-A and controls （ P 〈 0. 001 ）. No significant differences in the test evaluating depression symptom were found among three groups. Conclusions The hypertension and smoking play an important role in MCI-V. There are multiple domains of cognitive impairment in two subtypes of MCI. The CDT may reliably identify subjects with MCI and contribute to early detection of MCI. HIS may be useful to differentiate MCI-V from MCI-A.

关 键 词：血管疾病 脑血管意外 认知障碍 

分 类 号：R543[医药卫生—心血管疾病] R741.02[医药卫生—内科学]