老年心脑血管疾病患者的认知功能随访与脑血流灌注改变  

Cerebral blood flow and cognitive alterations in elderly patients with cardiocerebrovascular disease

作　　者：蔡华杰[1] 金贤[1] 陈启稚[2] 陆惠华[1] 方宁远[1] 

机构地区：[1]上海交通大学附属仁济医院老年病科,200001 [2]上海交通大学附属第九人民医院心内科,200011

出　　处：《老年医学与保健》2008年第4期212-214,228,共4页Geriatrics & Health Care

基　　金：上海市卫生局资助项目(编号004L12);上海市科委资助项目(编号00HX016)

摘　　要：目的本研究通过随访了解老年缺血性心脑血管疾病患者认知功能改变及其与脑血流灌注关系,同时观察心脑血管疾病患者临床事件和预后情况。方法选取陶冠心病和/或缺血性脑血管疾病住院治疗的老年人37例,进行认知功能测试,并作SPECT检查明确脑血流灌注情况,12～18个月后随访认知功能和严重心脑血管不良事件。结果随访前后中国成人智力量表(CISA)测验中B因素、D因素、言语商、拼图、词义分辨、找错和背数成绩的降低(P<0.05);简易精神状态量表(MMSE)、临床记忆量表测试成绩无统计学意义;认知功能下降者的左脑血流灌注较差(P<0.05);各组都有心脑血管不良事件发生,冠心病合并脑血管病组死亡率升高(21.43%,P<0.05)。结论老年缺血性心脑血管疾病患者的认知功能随增龄呈下降趋势,有关言语和抽象思维方面的认知功能更易下降;认知功能下降者的左脑血流灌注较差。Objective To investigate the relationship between cognitive decline and cerebral blood flow in old patients with cardiovascular or cerebrovascular disease. Clinical events and prognoses of these patients were also observed. Methods The study included 37 patients older than 60 years hospitalized for cardiovascular or cerebrovascular disease. Cognitive function was assessed by MMSE, the Chinese intelligence scale for adults （CISA） and clinical memory scale. SPECT was performed to evaluate cerebral blood flow. The patients were followed up for 12 - 18 months with cognitive function test and prevalence of cardiac or cerebrovascular events. Results There was no significant change in MMSE and clinical memory scale, while in CISA, B and D factors, language quotient and score of several subtests were significantly decreased. The patients with lower left brain perfusion were more likely to have impaired cognitive function. Conclusion Cognition in elderly patients with cardiocerebrovascular disease tended to be declining, especially in terms of the function of language tasks and abstract thinking and in patients with lower left brain perfusion. The patients who had clinical manifestations of both cardiac and cerebrovascular ischemia had the worst prognoses.

关 键 词：老年人 冠状动脉疾病 脑缺血 认知 脑血管循环 认知 体层摄影术 发射型计算机 单光子 

分 类 号：R749.1[医药卫生—神经病学与精神病学]