脑血管病患者的认知功能与脑白质损害  

Relationship between cognitive function and white matter hyperintensity in patients with cerebrovascular disease

作　　者：张娜[1] 贺建华[1] 易进[1] 梁玉兰[1] 李丛佳[1] 范冬宁[1] 张静[1] 

机构地区：[1]首都医科大学附属北京安贞医院精神心理科,北京100029

出　　处：《中国心理卫生杂志》2013年第11期825-828,共4页Chinese Mental Health Journal

摘　　要：目的：了解脑血管病患者的认知功能与脑白质损害的关系.方法：选取精神心理科和神经内科门诊的脑血管病患者356例,采集相关病史,用简明精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能.MMSE＜ 24界定为可疑痴呆,MoCA＜ 26界定为存在认知功能下降.参考FazekaS评分标准,将入组患者分成无白质损害组（Fazekas评分0分）,轻度白质损害组（Fazekas评分1分）,中重度白质损害组（Fazekas评分≥2分）.结果：356例脑血管患者中,脑血管病类型为大面积脑卒中65例（18.3％）,混合性脑血管病8例（2.2％,含可能的淀粉样脑血管病2例）,无症状脑梗塞107例（30.1％）,仅有脑白质损害者28例（7.8％）.356例患者中,有中重度脑白质损害的81例（23.4％）.356例患者中,353例MMSE成绩5～30分,平均（25.6±3.5）分,其中18.1％得分＜24,达到可疑痴呆状态;347例MoCA 5～28分,平均（19.4±3.9）分,其中94.5％得分＜26分.脑血管病患者的白质损害程度与MMSE、MoCA的总分及MoCA视空间执行功能、注意及定向分测验得分均呈负相关（r=-0.14、-0.15、-0.11、-0.16、-0.18,均P＜0.05）.结论：脑血管病患者的认知功能处于较低水平,并可能与脑白质损害存在较密切的关系.Objective：To investigate the relationship between cognitive function and white matter hypedntensity （WMH） in outpatients with cerebrovascular disease.Methods：Totally 356 outpatients with cerebrovascular disease were selected from the departments of psychology and neurology.The disease history was collected and the cognitive function was assessed with the Mini Mental Sate Examination （MMSE） and Montreal Cognitive Assessment （MoCA）.The MMSE score 〈 24 was defined as the suspected dementia,and the MoCA 〈 26 was defined as the presence of cognitive decline.According to the standard of Fazekas score,the patients were divided into non WMH group （Fazekas score =0）,mild WMH group （Fazekas score =1）,moderate and severe WMH group （Fazekas≥2）.Multivariate analysis was used to explore the possible causes that affected cognitive function.Results：Totally 356 patients with cerebrovascular disease who met the inclusion criteria were recruited.Among them,65 patients （18.3%） were with large area damage of brain,8 cases （2.2%） were with mixed cerebrovascular disease （2 of them were with possible amyloid cerebrovascular disease）,107 cases （30.1%） were with asymptomatic cerebral infarction,and 28 cases （7.8%） were only with white matter hypedntensity （WMH）.Totally 81 cases （23.4%）were with severe white matter hyperintensity.The MMSE total score was 5-30 in 353 subjects,and the average score was （25.6 ±3.5）.Among them,18.1% got a score of 〈24,reached suspected dementia state.The MoCA total score was 5-28 in 347 subjects,and the average score was （19.4 ±3.9）.Among them,94.5% with a score of 〈 26 had a varying degree of cognitive impairment.After controlling for age and education,in the patients with cerebrovascular disease,the level of WMH was negatively correlated with the total scores of MMSE and MoCA,and the MoCA subtests of visuospatial executive function,attention,and orientation （r =-0.14,-0.15,-0.11,-0.16,-0.18; Ps 〈0.05）.Conclusion：It suggests

关 键 词：白质损害 脑血管病 认知功能 横断面研究 

分 类 号：R743[医药卫生—神经病学与精神病学] B842.1[医药卫生—临床医学]