轻度认知障碍的神经心理表现及解剖结构损害的分型研究  

The Study of Neuropsychological Performence and Anatomic Structure Impaiment by MRI in Different Subtypes of Mild Cognitive Impairment

作　　者：董娜[1] 张贵丽[2] 张宏伟[3] 

机构地区：[1]天津市环湖医院电生理科,天津300140 [2]首都医科大学宣武医院神经内科,北京100053 [3]北京市海淀区妇幼保健院乳腺科,北京100060

出　　处：《中风与神经疾病杂志》2016年第1期49-53,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨不同类型的轻度认知功能障碍(mild cognitive impairment,MCI)患者人口统计学、认知损害及解剖结构损害的磁共振特点。方法对纳入的188例MCI患者和106例认知正常对照者进行多项神经心理学量表测试,按照认知受损区域及数目将MCI分为单领域遗忘型轻度认知功能障(amnestic mild cognitive impairment with single domain,a MCI-SD)组(n=48);多领域遗忘型轻度认知功能障(amnestic mild cognitive impairmen with multiple domain,a MCI-MD)组(n=82);单领域非遗忘型轻度认知功能障(non-amnestic mild cognitive impairment with single domain,na MCI-SD)组(n=24);多领域非遗忘型轻度认知功能障(non-amnestic mild cognitive impairment with multiple domain,na MCI-MD)组(n=34)。比较5组的人口统计学、神经心理及解剖结构的磁共振特点。结果与对照组比较,MCI患者起病年龄高且教育程度低(P<0.05)。MCI的4种亚型整体认知功能评分无差异但较对照组均有受损。Mo CA亚项视空间与执行能力测试中,a MCI-MD组和na MCI-MD受损较重,其次为na MCI-SD组(P<0.05)。在MRI检测中a MCI-MD组和a MCI-SD组均较对照组的颞叶内侧萎缩(Medial temporal lobe atrophy,MTA)的视觉评分高(P<0.05),但是na MCI-SD与na MCI-MD的MTA评分与对照组比较无差异(P>0.05)。4个MCI亚组的脑白质病变、皮质脑梗死、脑皮质萎缩发生率均大于对照组。na MCI-MD组的脑白质疏松病及脑萎缩病变较a MCI-SD组和a MCI-MD组的发病率均高。a MCI-SD组中皮质下腔隙性脑梗死病变的发生率较na MCI-MD和na MCI-SD组低。结论不同亚型的MCI患者显示海马、颞叶内侧面萎缩变性及血管病相关的病理改变的差异,揭示了临床认知损坏与病理学改变存在一致性,为MCI的正确诊断及治疗选择提供详尽的临床依据。Objective To evaluate the demographic features,cognitive impairments and To evaluate the demographic features,cognitive impairments and structure of the pathological anatomy by MRI in different MCI subtypes. Methods The188 subjects with MCI and 106 normal cognitive controls were systematically evaluated with Neuropsychological tests and performed by MRI scans. According to Petersen＇s standards,MCI patients were divided into 48 cases with a MCI-sd,82 cases with a MCI-md,24 cases with na MCI-sd,34 cases with na MCI-md groups. To compare different demography,cognitive impairments and structure of the pathological anatomy among the five groups. Results Compared with control,all the subtypes of MCI were higher in age onset but lower in education（ P 0. 05）. All MCI subtypes appeared global cognitive impairment compared with control. There were no statistical differences in global scores among MCI subtypes. Mo CA scores in the a MCl-sd and na MCl-sd group were higher than others,which in a MCI-MD was the lowest. In visuospatial and executive function test,there were no statistical differences between control and a MCI-sd groups（ P 0. 05）. The a MCI-MD and na MCI-MD groups coordinatively display greater more severe impairment than na MCI-SD group in visuospatial and executive function. Through MRI scans,our studies showed higher visual rated MTA sores were observed in a MCI-MD and a MCI-SD subjects compared with controls,while no significant difference presented in na MCI-MD and na MCI-SD subjects. Compared with controls,the higher prevalence of white matter hyperintensities（ WMH）,cortical cerebral infarction and cerebral cortical atrophy were showedshown. Lower prevalence of white matter hyperintensities（ WMH） and cerebral cortical atrophy were observed in a MCI-MD and a MCI-SD subjects than na MCI-MD subjects. Compared with a MCI-SD subjects,higher prevalence of cortical cerebral infarction in na MCI-MD and na MCI-SD subjects were observed. Conclusion Different subtypes of MCI demonstrate the differen

关 键 词：轻度认知功能障碍 亚型 磁共振 神经心理测试 颞叶内侧萎缩 

分 类 号：R749.1[医药卫生—神经病学与精神病学]