非出血型脑淀粉样血管病的认知特征——来自北京协和医院痴呆队列的数据  

Cognitive characteristics of non-hemorrhagic cerebral amyloid angiopathy--Data from PUMCH dementia cohort

作　　者：董立羚 王添艺 毛晨晖 姜宇涵 尚丽 包嘉璐 仇宇悦 褚珊珊 金蔚 倪俊 高晶 Liling Dong;Tianyi Wang;Chenhui Mao;Yuhan Jiang;Li Shang;Jialu Bao;Yuyue Qiu;Shanshan Chu;Wei Jin;Jun Ni;Jing Gao(Department of Neurology,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院神经科,疑难重症及罕见病重点实验室,100730

出　　处：《中华脑血管病杂志（电子版）》2024年第4期295-300,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：国家重点研发计划(2016YFC1306300);国家自然科学基金(30470618);中国医学科学院医学与健康科技创新工程(2021-1-I2M-1-020);衰老相关神经系统疾病诊疗关键技术研究(LY22D0070003828)。

摘　　要：目的探索以认知障碍为主要表现的非出血型脑淀粉样血管病(CAA)患者的认知特征,以指导临床认知训练。方法所有研究对象来自2007—2023年北京协和医院痴呆队列,完成病史采集、头颅MRI、认知评价、血液生化检查和基因测序。所有患者符合很可能CAA诊断标准,且无症状性脑出血病史。认知测评包括认知筛查和认知域测试,认知筛查包括简易智力状态检查量表(MMSE)、日常生活活动能力量表等;认知域测试涉及视空间、记忆、执行、推理计算和语言5个认知域。根据MMSE分数,将研究对象分成MMSE>20分(轻度认知障碍)亚组和10分<MMSE≤20分(中度认知障碍)亚组,采用方差分析比较2组内记忆认知域中听觉词语学习测验(AVLT)子项目(AVLT1-3)的差异。结果本研究共纳入34例CAA患者。男性12例,女性22例,年龄为(74.0±7.1)岁。记忆障碍和执行障碍最为突出,分别见于97.1%(33/34)和73.5%(25/34)的患者;其次为语言、视空间和推理计算障碍,分别见于38.2%(13/34)、35.3%(12/34)和5.9%(2/34)的患者。在MMSE>20分(n=20)和10分<MMSE≤20分(n=14)亚组中,AVLT1、AVLT2和AVLT3均存在显著上升趋势[(2.40±1.10)分vs(4.10±1.92)分vs(4.90±2.00)分,F=11.034,P<0.001;(1.64±0.84)分vs(2.21±1.48)分vs(3.36±1.95)分,F=4.793,P=0.014]。结论非出血型CAA患者以记忆和执行功能障碍为主要表现。轻、中度认知障碍(MMSE>10分)的CAA患者推理计算和学习能力相对保留,在临床工作中,可以利用这些保留的认知能力,对他们进行认知训练,以延缓其认知功能下降。Objective To explore the cognitive characteristics of non-hemorrhagic cerebral amyloid angiopathy(CAA)patients with cognitive impairment,in order to guide clinical cognitive training.Methods All the participants were from the dementia cohort of Peking Union Medical College Hospital(PUMCH)between 2007 and 2023.They all underwent history inquiry,brain MRI,cognitive evaluation,blood biochemical test,gene sequencing,and met the diagnostic criteria for probable CAA.None of them had a history of symptomatic intracranial hemorrhage.Cognitive evaluation included the mini-mental state exam(MMSE),activities of daily life,as well as cognitive domain assessments(including visuospatial,memory,executive,reasoning and linguistic domains).According to the MMSE scores,the subjects were divided into two subgroups:one with MMSE scores greater than 20,and another with MMSE scores between 10 and 20,inclusive.Analysis of variance was used to compare the three immediate memory items of auditory verbal learning test(AVLT)between the two groups.Results A total of 34 patients with CAA were enrolled,including 12 males and 22 females with a mean age of(74.0±7.1)years.Memory and executive disorders were the most prominent,occurring in 97.1%(33/34)and 73.5%(25/34)subjects.Linguistic,visuospatial,and reasoning dysfunctions were observed in 38.2%(13/34),35.3%(12/34),and 5.9%(2/34)of subjects,respectively.Among the MMSE>20(n=20)and 10<MMSE≤20(n=14)subgroups,AVLT1,AVLT2,and AVLT3 demonstrated a significantly increasing trend[(2.40±1.10)vs(4.10±1.92)vs(4.90±2.00),F=11.034,P<0.001;(1.64±0.84)vs(2.21±1.48)vs(3.36±1.95),F=4.793,P=0.017].Conclusion The non-hemorrhagic CAA patients are mainly characterized by memory and executive dysfunction.Those with mild-to-moderate cognitive impairment,as indicated by MMSE scores greater than 10,have relatively preserved reasoning and learning abilities.In clinical practice,we can leverage these reserved cognitive abilities to provide them cognitive training,with the aim of delaying their cognitive decline

关 键 词：脑淀粉样血管病 认知功能 记忆功能 执行功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]