腔隙性梗死后的认知障碍和神经代谢产物变化的关系  

Cognitive deficits and changes in neurometabolites after a lacunar infarct

作　　者：Van Zandvoort M.J.E. Van Der Grond J. Kappelle L.J. DeHaan E.H.F. 赵正卿 

机构地区：[1]Utrecht University,Van Unnikgebouw Psychol. Laboratory, Heidelberglaan 2,3584 CS Utrecht, Netherlands Dr.

出　　处：《世界核心医学期刊文摘（神经病学分册）》2005年第8期43-44,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.

关 键 词：腔隙性梗死 认知障碍 神经心理 代谢产物 大脑半球 磁共振质子波谱 心肌梗死组 乳酸盐 半卵圆中心 肌酸 

分 类 号：R749.1[医药卫生—神经病学与精神病学]