遗忘型轻度认知障碍患者脑灰质体积变化与认知和步态障碍的相关性研究  

The correlation among altering gray matter volume,cognition and gait disorder in patients with amnestic mild cognitive impairment

作　　者：尹文文 余先锋 周霞[1] 游孟哲 黄超娟 朱小群[1] 孙中武[1] Yin Wenwen;Yu Xianfeng;Zhou Xia;You Mengzhe;Huang Chaojuan;Zhu Xiaoqun;Sun Zhongwu(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《中华神经科杂志》2021年第7期640-648,共9页Chinese Journal of Neurology

基　　金：国家自然科学基金面上项目(81771154);国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1305900)。

摘　　要：目的探讨遗忘型轻度认知障碍(aMCI)患者脑灰质体积变化与认知和步态障碍的相关性。方法收集2018年7月至2020年8月安徽医科大学第一附属医院收治的aMCI患者36例,同期纳入年龄、性别、教育程度匹配的正常对照33名。采用简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、剑桥认知检查量表中文版(CAMCOG-C)、日常生活能力量表(ADL)、老年抑郁量表(GDS)等对受试者进行神经心理学评估。评估受试者起立行走测试(TUG)、起立行走双重任务测试(D-TUG)和Berg平衡量表(BBS)测评结果;使用智能能量消耗和日常活动记录仪采集受试者步长、步速、步频。对受试者均进行3.0 T磁共振成像扫描,获取高分辨T1结构像。使用基于体素的形态学测量法(VBM)比较aMCI患者与正常对照之间灰质体积的差异。将差异脑区灰质体积分别与认知评分、步态参数进行偏相关分析;认知评分与步态进行偏相关分析;全脑灰质体积与步态进行线性回归分析。结果aMCI组MMSE、MoCA、CAMCOG-C总分及分项目评分均显著低于正常对照组(均P<0.05)。aMCI组TUG、D-TUG时长增加,步速减慢,步长缩短,BBS评分降低,步频减少(均P<0.05)。VBM分析结果显示aMCI组全脑灰质体积较正常对照组减小,aMCI组在感兴趣区1(包括右侧海马、右侧海马旁回、右侧杏仁核等)、感兴趣区2(右侧颞中回)、感兴趣区3(右侧顶下缘角回)、感兴趣区4(右侧枕叶)、感兴趣区5(双侧眶部额叶)、感兴趣区6(左侧额中回、直回)、感兴趣区7(左侧梭形回、左侧海马旁回等区域)等部位灰质体积较正常对照组显著减小[高斯随机场(GRF)校正,双侧检验,体素水平P<0.001,团块水平P<0.05]。aMCI组中感兴趣区1灰质体积与定向(r=0.437,P=0.012)、记忆(r=0.360,P=0.043)、执行(r=0.414,P=0.019)等评分呈正相关,与ADL评分呈负相关(r=-0.529,P=0.002);感兴趣区2灰质体积与ADL评分呈负相关(r=-0.400,P=0Objective To investigate the impact of altering brain gray matter volume(GMV)on cognition and gait disorder in patients with amnestic mild cognitive impairment(aMCI).Methods Thirty-six patients with aMCI,who admitted to the First Affiliated Hospital of Anhui Medical University from July 2018 to August 2020,were collected,and 33 normal controls(NC)matched with age,sex and education level were included in the same period.The neuropsychological assessment was done in all the subjects using Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment scale(MoCA),Cambridge Cognitive Examination-Chinese version(CAMCOG-C),Geriatric Depression Scale(GDS)and Activities of Daily Living scale(ADL).The timed up and go test(TUG),dual task of timed up and go test(D-TUG)and Berg Balance Scale(BBS)were used in the subjects for assessment.The parameters such as stride length,gait speed,gait frequency were collected by intelligent device for energy expenditure and activity.All the subjects received 3.0 T magnetic resonance imaging scan to obtain high-resolution T1 structural images.Voxel-based morphometry(VBM)was used to compare the difference of GMV between aMCI patients and NC.Partial correlation analysis was performed among altering GMV in the regions of interest(ROI),cognitive score and gait parameters,respectively.Linear regression analysis was used between whole brain GMV and gait parameters.Results The scores of MMSE,MoCA,CAMCOG-C and the subitems of CAMCOG-C in aMCI group were significantly lower than those in NC group(P<0.05).In aMCI patients,both the test time of TUG and D-TUG increased,gait speed slowed down,stride length shortened,and stride frequency and BBS score decreased(P<0.05).VBM analysis showed that the whole brain GMV in aMCI patients was obviously lower than that of NC.In the aMCI group,GMV in ROI1(right hippocampus,right parahippocampal gyrus,right amygdala and right fusiform gyrus),ROI2(right middle temporal gyrus),ROI3(right angular gyrus),ROI4(right occipital lobe),ROI5(bilateral orbital frontal lobe

关 键 词：遗忘型轻度认知障碍 灰质体积 步态障碍 认知 

分 类 号：R749.1[医药卫生—神经病学与精神病学]