认知功能损害与缺血性脑白质病变的相关性研究  

Correlation of white matter ischemic lesion with cognitive function impairment

作　　者：吕祥兄[1] 方凯[1] 李晓彤[1] 石海涛[1] 

机构地区：[1]浙江萧山医院神经内科,杭州311201

出　　处：《浙江医学》2011年第1期35-36,91,共3页Zhejiang Medical Journal

摘　　要：目的了解缺血性脑白质病变（WMIL）患者认知功能改变的特点，初步探讨WMIL与认知功能损害的关系。方法采用蒙特利尔评估量表北京版（MoCA）分别对年龄、受教育程度等相匹配的30例WMIL患者和30例对照者的认知功能进行评定，同时使用Wahlund等提出的年龄相关白质改变评分量表（WMLs评分）和采用胆碱能通路高信号评分量表（CHIPs评分）对wMIL患者的脑白质病变（WML）情况进行测定评分。结果wMIL患者总体认知功能较对照组明显下降（P〈0．01）。其中视空间与执行、记忆、注意和语言均较对照组明显下降（P〈0．01），且视空间与执行、记忆、注意力及MoCA总分与脑白质胆碱能通路损害程度（CHIPs评分）相关（P〈0．01），而视空间与执行和MoCA总分与脑白质总体病变程度（WML评分）相关（P〈0．01）；而命名、定向和抽象能力与对照组比较差异无统计学意义（P〉0．05）。结论WMIL患者存在认知功能损害，其中以视空间与执行、记忆和注意能力损害突出，WMIL认知功能损害可能与胆碱能通路的白质损伤程度相关。提示胆碱能通路损伤可能参与认知损害的发病机制。Objective To investigate the cognitive function impairment in patients with white matter ischemic lesions （WMIL）. Methods The cognitive function of 30 patients with WMIL and 30 age and education-matched controls were measured using the Montreal Cognitive Assessment scale （MoCA）. The severity of white matter lesions was scored and classified by the age-related white matter lesion scale （WMLs）and the cholinergic pathways hyperintensity scale （CHIPs）. Results Compared with the controls, WMIL patients demonstrated decline in the cognitive function, especially in the language, memory, attention,visuoconstructional and executive functions, while the function of naming,abstraction and orientation showed no significant difference. In addition, the CHIPs scores were correlated with cognitive function,memory,attention,visuoconstructional and executive functions and WMLs scores were correlated with the angnitive function and visuoconstructiond and executivefunction. Conclusion WMIL patients demonstrated a selective impairment in cognitive function. The results suggest that the cognitive function may have different neuromechanisms and indicates cholinergic pathways may be the neuromechnism of the memory, attention,visuoconstructional and executive functions.

关 键 词：脑白质病变 认知功能 胆碱能通路 

分 类 号：R749.16[医药卫生—神经病学与精神病学]