脑白质病变程度对认知功能的影响  

Effect of the severity of white matter lesion on cognitive function: a clinical study

作　　者：于洁[1] 王海丽[1] 周丽丽[1] 周国平[1] 

机构地区：[1]首都医科大学电力教学医院神经内科,北京100073

出　　处：《中国脑血管病杂志》2013年第12期653-656,658,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨脑白质病变(WML)严重程度对认知功能的影响。方法收集2012年1月—2013年1月在首都医科大学电力教学医院经头部MRI诊断为WML的患者48例。应用蒙特利尔认知评估量表(MoCA)和简易精神状态量表(MMSE)对患者的认知功能进行测评,应用与年龄相关的脑白质改变分级量表(ARWMCRs)对WML的严重程度进行评分。根据ARWMCRs评分,将WML患者分为轻度组(<7分),和中重度组(≥7分),比较两组患者的认知功能,并分析ARWMCRs评分与认知功能评分的相关性。结果①WML轻度组MoCA评分为(22.3±3.0)分,高于中重度组的(20.3±2.3)分,P<0.01;两组MMSE评分差异无统计学意义。②多元逐步回归分析显示,ARWMCRs评分与MoCA(b=-0.105,P<0.01)及MMSE评分(b=-0.057,P<0.01)呈负相关。③Spearman相关分析显示,ARWMCRs评分与MoCA量表中的视觉空间执行功能(r s=-0.398)、即刻回忆(r s=-0.459)、注意力(r s=-0.332)、语言(r s=-0.184)、抽象(r s=-0.229)、延迟回忆(r s=-0.348)及分类提示(r s=-0.236)子项呈负相关,均P<0.01;与MMSE评分量表中的计算力(r s=-0.235)、延迟回忆(r s=-0.294)及语言(r s=-0.423)子项呈负相关,均P<0.01。结论 WML严重程度对认知功能有影响,WML程度越严重,认知功能受损越重。Objective To investigate the effect of the severity of white matter lesion （WML） on cognitive function. Methods A total of 48 patients diagnosed as WML with head magnetic resonance imaging （MRI） at Beijing Electric Power Teaching Hospital, Capital Medical University from January 2012 to January 2013 were enrolled. The cognitive function of the patients was assessed with Montreal cognitive assessment （MoCA） scale and the mini-mental state examination （MMSE） scale. The severity of WML was scored by using age-related white matter changes rating scale （ ARWMCRs）. According to ARWMCRs score, the WML patients were divided into either a mild WML group （ 〈7 points） or a moderate to severe WML group （/〉 7 points）. The correlation between ARWMCRs scores and cognitive function scores was analyzed. Results The MoCA score in the mild WML group was 22.3 ：t： 3.0. It was higher than 20.3 ：i： 2.3 in the moderate to severe WML group （ P 〈 0.01 ）. There was no significant difference in MMSE scores between the two groups. @Multivariate stepwise regression analysis showed that ARWMCRs score was negatively correlated with MoCA score （ b = - 0. 105, P 〈 0.01 ） and MMSE score （ b = - 0. 057, P 〈 0.01 ）. （~）Spearman correlation analysis showed that ARWMCRs score was negatively correlated with the subitems in the MoCA scale, including visuospatial executive function （r = -0.398 ） , immediate memory （ r = - 0. 459）, attention （ r = - 0.332）, language （ r = - 0. 332）, abstraction （ r = - 0.229）, delayed memory （ r = - 0. 348 ）, and classification reminder （ r = - 0. 236 ） （ all P 〈 0.01 ） ; and it was negatively correlated with the subitems in the MMSE scale score, including computing power （r = -0.235）, delayed memory （r = - 0. 294）, and language （r = -0.423,all P 〈 0. 01）.Conclusions The severity of WML has influence on cognitive function. The more severe the WML, the more severe the cognitive impairment will be.

关 键 词：脑白质病变 疾病严重程度指数 认知障碍 

分 类 号：R742.89[医药卫生—神经病学与精神病学]