成人缺血性脑血管病的认知损害特征分析  

Characteristics of cognitive impairment in adults with cerebral ischemia

作　　者：雷宇[1] 郭起浩[2] 李彦江[1] 江汉强[1] 倪伟[1] 顾宇翔[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华医学杂志》2014年第13期984-989,共6页National Medical Journal of China

基　　金：十二五国家科技支撑计划（2011BAI08B04）;上海市市级医院新兴前沿技术联合攻关项目（SHDC12010118）

摘　　要：目的 分析成人缺血性脑血管病患者的认知损害以为其诊治提供依据.方法 连续收集2012年6月至2013年6月在复旦大学附属华山医院神经外科就诊的缺血性脑血管病患者的临床资料,选取其中符合研究标准的患者56例,使用简易精神状态量表（MMSE）及记忆与执行筛查量表（MES）进行血管性认知损害（VCI）筛查.根据筛查结果将病例组分为3组：血管性痴呆亚组11例（VaD亚组）、血管性轻度认知损害亚组22例（VaMCI亚组）及无认知损害亚组23例（非VCI亚组）,比较3组的一般情况;利用成套神经心理学量表分析VaMCI亚组的认知损害特征;根据病例组VCI的组成比分析缺血性脑卒中或短暂性脑缺血发作（TIA）与VCI各成分的关系.结果 病例组和匹配的48名健康对照在年龄、性别和受教育年限的差异无统计学意义（P＞0.05）,病例组MMSE分数[（25.0±5.6）分比（28.0±1.4）分,P=0.007]和MES分数[（67±21）分比（84±7）分,P＜0.001]均显著低于健康对照组.病例组中33例（58.9％）存在VCI,包括VaD亚组11例（19.6％）,VaMCI亚组22例（39.3％）及非VCI亚组23例（41.1％）,VaD/VaMCI为1/2;VaD亚组男性比例（36.4％比78.3％,P=0.017）和受教育年限[（8±3）年比（12±4）年,P=0.010]均显著低于非VCI亚组;VaMCI亚组受教育年限[（7±3）年比（12±4）年;P =0.001]显著低于非VCI亚组;3个亚组的MMSE和MES分数与认知损害严重程度符合良好.本研究使用的整套神经心理学评估量表具有较好的敏感性和特异性,所有VaMCI患者（22例）均在至少一种执行功能/注意力测试中得分较低,21例（95.5％）在至少一种记忆测试中得分较低,17例（77.3％）在至少一种语言测试中得分较低,16例（72.7％）在至少一种视空间功能测试中得分较低;所有VaMCI患者均表现为2个以上认知域不同程度受损,其中50％为4个认知域均受损,45％为3个认知域均受损,余5％为2�Objective To explore the characteristics of cognitive impairment of cerebral ischemia in adults to provide rationales for proper diagnosis and targeted treatment.Methods A battery of standardized neuropsychological tests including mini-mental state examination （MMSE） and memory and executive screening （MES） was administered in a cohort of consecutive patients with cerebral ischemia.According to the screening results,they were divided into 3 subgroups of vascular dementia （VaD）,vascular mild cognitive impairment （VaMCI） and non-vascular cognitive impairment （VCI）.The general profiles of 3 subgroups were compared and the characteristics of VaMCI subgroup examined.Then the relationship between the composition of cognitive impairment and the type of ischemia （stroke and transient ischemic attack） was analyzed.Results Fifty-six patients and 48 healthy subjects （normal control group） matched with regards to age,gender and education were recruited.Compared to normal control group,there was a decline in the scores of MMSE [（25.0 ±5.6） vs （28.0 ± 1.4） ; t =2.695,P =0.007] and MES [（67 ±21） vs （84 ± 7） ; z =3.860,P =0.000] in case group.There were 33 cases （58.9％） of VCI in case group,including 11 （19.6％） in VaD subgroup,22 （39.3％） in VaMCI subgroup and 23 （41.1％） in non-VCI subgroup.And the rate of VaD/VaMCI was 1/2.The percentage of males （36.4％ vs 78.3 ％ ; x2 =5.720,P =0.017） and education [（8 ± 3） vs （12 ± 4） ; P =0.010] of VaD subgroup were significantly lower than that of non-VCl subgroup; the education of VaMCI subgroup was significantly lower than that of non-VCI subgroup [（7 ± 3） vs （12 ± 4） ; P =0.001] ; a positive correlation existed between scores of MMSE/MES and cognitive impairment.The neuropsychological tests were both sensitive and specific.In VaMCI subgroup,22 cases （100％） presented with a deficit of at least 1 certain executive function/attention index,21 （95.5％） with at least 1 certain memory i

关 键 词：脑 缺血性病变 痴呆 血管性 神经心理学测验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]