引用本文:严一丹,张 羽,杨素新,章 腾,赵 莉,唐铁钰,许笑天.脑白质高信号的中青年轻度认知功能障碍患者认知功能特点及脑血流改变情况分析[J].中国临床新医学,2024,17(6):632-638.
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脑白质高信号的中青年轻度认知功能障碍患者认知功能特点及脑血流改变情况分析
严一丹1,2,张 羽1,杨素新1,2,章 腾1,2,赵 莉1,2,唐铁钰1,许笑天1
1.扬州大学附属医院神经内科,江苏 225000;2.扬州大学医学院,江苏 225000
摘要:
[摘要] 目的 分析脑白质高信号(WMH)的中青年轻度认知功能障碍(MCI)患者的认知功能特点及脑血流改变情况。方法 招募2023年2月至12月扬州大学附属医院神经内科收治的WMH患者70例,年龄35~65岁,均行神经心理量表评分、颅脑MRI及经颅多普勒(TCD)检查,收集其一般临床资料。根据北京版蒙特利尔认知量表(MoCA)评分将研究对象分为MCI组(MoCA评分20~24分,36例)和对照组(MoCA评分25~30分,34例)。比较两组临床基线资料、认知亚域评分、TCD指标。采用logistic回归分析探讨大脑中动脉(MCA)搏动指数(PI)与MCI发生的关联性。结果 对照组MoCA的视空间与执行功能、命名、注意力、语言、抽象思维以及延迟记忆能力显著优于MCI组(P<0.05)。MCI组的听觉词语学习测验华山版(AVLT-H)长延迟回忆得分及总分低于对照组,差异有统计学意义(P<0.05)。MCI组词语流畅性实验(VFT)得分、符号数字转化测验(SDMT)得分、画钟测验(CDT)得分低于对照组,连线测试A(TMT-A)、连线测试B(TMT-B)耗时长于对照组,差异有统计学意义(P<0.05)。MCI组MCA的PI水平高于对照组,差异有统计学意义(P<0.05),其余TCD指标比较差异无统计学意义(P>0.05)。经调整性别、高血压病史、糖尿病史、高血脂病史、吸烟史及饮酒史因素后,logistic回归分析结果显示,MCA的PI水平升高是促进MCI发生的危险因素[OR(95%CI)=348.877(2.046~59 419.483),P=0.026]。结论 WMH的中青年MCI患者的语言、视空间、记忆、执行、注意与处理速度等认知亚域功能均有所下降。MCA的PI水平升高有助于识别MCI高危人群。
关键词:  轻度认知功能障碍  经颅多普勒  脑白质高信号  血流动力学  认知功能  中青年
DOI:10.3969/j.issn.1674-3806.2024.06.08
分类号:
基金项目:国家自然科学基金项目(编号:81901084)
Analysis on the cognitive function characteristics and changes in cerebral blood flow in young and middle-aged patients with mild cognitive impairment and white matter hyperintensities
YAN Yidan1,2, ZHANG Yu1, YANG Suxin1,2, ZHANG Teng1,2, ZHAO Li1,2, TANG Tieyu1, XU Xiaotian1
1.Department of Neurology, Affiliated Hospital of Yangzhou University, Jiangsu 225000, China; 2. Yangzhou University Medical College, Jiangsu 225000, China
Abstract:
[Abstract] Objective To analyze the cognitive function characteristics and changes in cerebral blood flow in young and middle-aged patients with mild cognitive impairment(MCI) and white matter hyperintensities(WMH). Methods A total of 70 WMH patients, aged 35-65 years, admitted to Department of Neurology, Affiliated Hospital of Yangzhou University from February 2023 to December 2023 were recruited. Neuropsychological scale score, brain magnetic resonance imaging(MRI) and transcranial Doppler(TCD) examinations were performed in all the patients, and the patients′ general clinical data were collected. According to the Beijing Version of Montreal Cognitive Assessment(MoCA) scores, the study subjects were divided into MCI group(with MoCA scores of 20-24 points, 36 cases) and control group(with MoCA scores of 25-30 points, 34 cases). The clinical baseline data, cognitive subdomain scores and TCD indicators were compared between two groups. Logistic regression analysis was used to explore the correlation between pulsatility index(PI) of middle cerebral artery(MCA) and the occurrence of MCI. Results The visual space and execute function, naming, attention, language, abstract thinking and delayed memory ability of MoCA in the control group were significantly better than those in the MCI group(P<0.05). The long delayed recall scores and total scores of Auditory Verbal Learning Test-Huashan Version(AVLT-H) in the MCI group were lower than those in the control group, and the differences were statistically significant(P<0.05). The scores of Verbal Fluency Test(VFT), Symbol Digit Modalities Test(SDMT) and Clock Drawing Test(CDT) in the MCI group were lower than those in the control group. The duration of Trail Making Test A(TMT-A) and Trail Making Test B(TMT-B) in the MCI group was longer than that in the control group, and the difference was statistically significant(P<0.05). The PI level of MCA in the MCI group was higher than that in the control group, and the difference was statistically significant(P<0.05). There were no statistically significant differences in the other TCD indicators(P>0.05). After adjusting for gender, history of hypertension, history of diabetes, history of hyperlipidemia, history of smoking and history of alcohol drinking, the results of logistic regression analysis showed that the increased PI level of MCA was a risk factor for promoting the occurrence of MCI[OR(95%CI)=348.877(2.046-59 419.483), P=0.026]. Conclusion The cognitive subdomain functions of language, visual space, memory, execution, attention and processing speed in young and middle-aged MCI patients with WMH are all reduced. The elevated PI level of MCA helps to identify the high-risk population.
Key words:  Mild cognitive impairment(MCI)  Transcranial Doppler(TCD)  White matter hyperintensities(WMH)  Hemodynamics  Cognitive function  Young and middle-aged