轻中度阿尔茨海默病患者肌肉力量与认知功能、内侧颞叶萎缩的相关性  

Correlation of muscle strength with cognitive function and medial temporal lobe atrophy in patients with mild to moderate Alzheimer′s disease

作　　者：刘善雯 李萌 朱江涛[2] 张迎春[3] 吴永华[4] 刘春风[1] 胡华[1] Shanwen Liu;Meng Li;Jiangtao Zhu;Yingchun Zhang;Yonghua Wu;Chunfeng Liu;Hua Hu(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Imaging,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Ultrasound,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Geriatrics,Suzhou Municipal Hospital affiliated to Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]苏州大学附属第二医院神经内科,苏州215004 [2]苏州大学附属第二医院影像科,苏州215004 [3]苏州大学附属第二医院超声科,苏州215004 [4]南京医科大学附属苏州医院老年医学科,苏州215002

出　　处：《中华医学杂志》2022年第35期2786-2792,共7页National Medical Journal of China

基　　金：江苏省老年健康科研项目(LD2021031);苏州市科技发展计划(SYSD2019109)。

摘　　要：目的分析轻中度阿尔茨海默病(AD)患者肌肉力量与认知功能、内侧颞叶萎缩(MTA)间的相关性。方法选取2021年1—12月在苏州大学附属第二医院神经内科记忆障碍门诊确诊的80例AD患者(轻度41例,中度39例)和同期体检中心体检的43名对照者(NC),收集一般资料、肌少症相关指标、神经心理学测试与MTA评分。肌少症相关指标中四肢骨骼肌量指数(ASMI)评估肌肉量,握力与5次起坐时间评估肌肉力量,6 m步速评估躯体功能。认知功能量表为简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行功能筛查量表(MES)、数字符号转换测验(DSST)、数字广度测试(DST)、词语流畅性试验(VFT),DST包括顺序(FDST)和倒序(BDST)。受试者均行3.0 T颅脑冠状位三维梯度回波序列磁共振检查,MTA量表评估内侧颞叶萎缩程度。分析三组肌少症相关指标、认知评分、MTA评分间的差异,并且两两之间进行偏相关分析。结果80例AD患者,男24例、女56例,年龄(72±7)岁,其中轻度AD患者41例,中度AD患者39例;43名NC,男19名、女24名,年龄(70±6)岁。中度AD组病程长于轻度AD组[34.0(25.0,43.5)个月比24.0(11.0,34.0)个月,P<0.001]。三组肌少症相关指标及MTA评分比较,组间差异均有统计学意义(均P<0.001),如5次起坐时间[(13.6±1.8)s比(11.5±1.7)s比(10.3±1.9)s,P<0.001],MTA评分[2.0(2.0,3.0)分比1.0(1.0,2.0)分比0(0,0)分,P<0.001]。神经心理学测试中,轻、中度AD组MMSE、MoCA、MES、VFT得分均低于NC组,且中度AD组低于轻度AD组(均P<0.001)。AD组肌少症相关指标中,尤其是肌肉力量,与多个认知功能领域和MTA评分相关。握力与MMSE、MoCA、MES、FDST(r=0.387、0.418、0.522、0.484,均P<0.001)、DSST(r=0.327,P=0.006)、VFT得分(r=0.354,P=0.003)呈正相关,与MTA评分(r=-0.631,P<0.001)呈负相关;5次起坐时间与MMSE、MoCA、MES、DSST、FDST、VFT(r=-0.583、-0.587、-0.814、-0.591、-0.552、-0.485,均P<0.001)、BDST(r=-0Objective To analyze the correlation of muscle strength with cognitive function and medial temporal lobe atrophy(MTA)in patients with mild to moderate Alzheimer′s disease(AD).Methods General information,sarcopenia-related indicators,neuropsychological tests and MTA score were collected in 80 confirmed AD patients(41 mild and 39 moderate patients)and 43 normal controls(NC)from the Memory Disorders Clinic of Department Of Neurology in the Second Affiliated Hospital of Soochow University between January and December 2021.Appendicular skeletal muscle mass index(ASMI),grip strength and 5-times sit-to-stand time and 6-m gait speed were used for assessing muscle mass,muscle strength and physical function,respectively.Cognitive function was assessed by Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment scale(MoCA),Memory and Executive Screening Scale(MES),Digit Symbol Substitution Test(DSST),Digital Span Test(DST)and Verbal Fluency Task(VFT),respectively.DST included Forward Digit Span Test(FDST)and Backward Digit Span Test(BDST).All the subjects underwent 3.0T coronal three-dimensional gradient echo sequence MRI.MTA scale was performed to evaluate the degree of medial temporal lobe atrophy.The differences in the sarcopenia-related indicators,cognitive score and MTA score were analyzed among the three groups,and the partial correlation analysis was performed between the inter-groups.Results Eighty AD patients(24 males and 56 females)were included,aged(72±7)years old,with 41 mild and 39 moderate patients.Meanwhile,43 NC included 19 males and 24 females,with a mean age of(70±6)years old.The disease duration in moderate AD patients was longer than that of mild AD patients[34.0(25.0,43.5)months vs 24.0(11.0,34.0)months,P<0.001].The differences of sarcopenia-related indicators and MTA score among the three groups were statistically significant(all P<0.001),including 5-times sit-to-stand time[(13.6±1.8)s vs(11.5±1.7)s vs(10.3±1.9)s,P<0.001]and MTA score[2.0(2.0,3.0)vs 1.0(1.0,2.0)vs 0(0,0),P<0.001].In neu

关 键 词：阿尔茨海默病 肌肉力量 认知功能 内侧颞叶萎缩 病例对照研究 

分 类 号：R749.16[医药卫生—神经病学与精神病学]