脑小血管病认知功能障碍与脑电的相关性研究

发布时间：2019-05-30 05:58

【摘要】：目的:分析脑小血管病性认知功能障碍(CSVCI)与脑电改变的特点,探讨两者之间的相关性,为早期发现脑小血管病认知功能改变及监测病情的变化提供客观依据。方法:选取2015年01月~2017年01月于吉林大学白求恩第一医院住院或记忆门诊就诊的CSVCI患者81例作为本课题的研究对象。记录患者的临床资料、神经心理学测验评分及4小时录像脑电图(EEG)监测结果。根据美国《精神疾病诊断和统计手册》第4版(Ds M~IV)的诊断标准,将研究对象分为2组:非痴呆性血管性认知功能障碍组(VCIND)和血管性痴呆组(VaD)。使用SPSS19.0软件进行数据的统计学分析。结果:1、VCIND和VaD组在年龄、性别、受教育程度、有无高血压、吸烟史、饮酒史、高脂血症病史、糖尿病病史方面差异无统计学意义(P0.05)。2、VCIND和VaD组在MMSE总分及分项评分、Mo CA总分及各认知域评分、MES总分及分项评分相比(P0.05)有统计学差异。3、本课题81例研究对象中正常EEG为11.1%、轻度异常32.1%、中度异常48.1%、重度异常8.6%。VCIND组正常EEG为17.6%,轻度异常35.3%,中度异常47.1%,无重度异常EEG;与之对应的VaD组分别为6.4%、29.8%、48.9%及14.9%。两组间比较差异(P0.05)有统计学意义。4、CSVCI中正常EEG为11.1%、仅背景改变为21.0%,仅异常波存在的为18.5%,兼有背景和异常波为49.4%。VCIND组正常EEG为17.6%,仅背景改变为35.3%,仅异常波存在及兼有背景和异常波存在的EEG为23.5%;VaD组正常EEG为6.4%,仅背景改变为10.6%,仅异常波存在为14.9%,兼有背景及异常波改变的EEG为68.1%。两组间比较(P0.05)差异有统计学意义。5、81例研究对象中无异常波的EEG为32.1%,少量异常波EEG为27.2%,中量异常波的EEG为30.9%,大量异常波的EEG为9.9%。其中VCIND组分别为52.9%、32.4%、14.7%、0.0%;相对应的VaD组分别是17.0%、23.4%、42.7%及17.0%。两组间比较差异有统计学意义(P0.01)。6、比较VCIND组及VaD组EEG一般特征,VaD组较VCIND组脑电背景频率变慢,背景脑电及局灶性慢波活动增多,节律泛化、调节调幅异常及异常波的比例也增多,且统计学意义(P0.05)。7、正常EEG、轻度异常EEG、中度及重度异常EEG4组间对应的MMSE评分(23.89±4.137 vs 22.15±5.936 vs 21.64±5.480 vs 14.43±4.577)、Mo CA评分(18.78±5.333 vs 16.58±5.907 vs 15.36±5.603 vs 8.57±1.272)、MES评分(63.14±17.790 vs 56.50±23.376 vs 54.57±22.909 vs 33.00±14.434)及ADL评分(26.22±6.037 vs 30.46±13.252 vs 31.36±12.592 vs 47.43±15.757)组间比较差异有统计学差异(P0.05)。无异常波、少量、中量及大量异常波存在的EEG4组间MMSE(24.65±4.039 vs 22.05±5.481 vs 19.88±5.630 vs 14.13±4.324)MOCA(18.69±4.488 vs 15.82±5.395 vs 14.24±6.112 vs 8.63±3.159)、MES(66.23±16.535 vs 57.42±20.868 vs 46.33±24.259 vs 34.38±17.808)、ADL(26.00±5.987 vs 29.95±13.415 vs 35.08±13.687 vs 46.38±17.533)的评分上相比较差异有统计学差异(P0.05)。结论:1、随着疾病的发展,CSVCI患者的执行功能、记忆功能及语言能力等各认知域均有受损。2、CSVCI患者中EEG异常比例较高,且以轻、中度异常为主,随着认知功能障碍程度的加重,异常EEG的比例增多异常程度也加重。即EEG对CSVCI的诊断有较高的敏感性,并且能反应认知功能障碍的进展。3、CSVCI患者EEG的改变可以是背景的改变、局灶性异常波或合并存在,VCIND中以背景改变为主要形式,当认知障碍程度进一步加重,则以背景及异常波合并存在为主。4、随着认知功能障碍程度的加重,脑电背景频率变慢,背景脑电及局灶性慢波活动增多,节律泛化、调节调幅异常及局灶性异常波的比例也增多。5、CSVCI患者的EEG局灶性改变中可以少量、中量或大量异常波,其中以少量及中量改变为主。随着认知障碍程度的加重,中量及大量异常波的EEG比例增多。6、EEG异常程度分级及异常波的数量均与认知量表及日常生活能力表现有关。
[Abstract]:Objective: To study the relationship between the changes of the cognitive function (CVCI) and the EEG in the brain, and to provide an objective basis for the early detection of the change of the cognitive function of the brain and the change of the monitoring condition. Methods:81 patients with CVCI who were admitted to the hospital or memory of the first hospital in Bethune, Jilin University from January 2015 to January 2017 were selected as the subject of this study. The patient's clinical data, the neuropsychological test scores, and the 4-hour Video Electroencephalogram (EEG) monitoring were recorded. The subjects were divided into two groups according to the diagnostic criteria of the American Version 4 (Ds M-IV): a non-dementia vascular cognitive impairment group (VCIND) and a vascular dementia group (VaD). Statistical analysis of data was performed using the SPSS19.0 software. Results: There was no significant difference in the age, sex, the degree of education, the history of hypertension, the history of smoking, the history of drinking, the history of hyperlipidemia and the history of diabetes (P0.05). There was a statistical difference between the total scores of MES and the sub-item scores (P0.05).3. The normal EEG in 81 subjects in this study was 11.1%, slight abnormal 32.1%, moderate abnormal 48.1%, and severe abnormal 8.6%. The normal EEG of the VCIND group was 17.6%, the mild abnormality was 35.3%, the middle abnormality was 47.1%, and no severe abnormal EEG was found. The corresponding VaD groups were 6.4%, 29.8%, 48.9% and 14.9%, respectively. The difference between the two groups was statistically significant (P0.05).4. The normal EEG in the CVCI was 11.1%, only the background change was 21.0%, only the abnormal wave was 18.5%, and the background and the abnormal wave were 49.4%. The normal EEG of the VCIND group was 17.6%, and the background was only 35.3%. The EEG in the presence of only the abnormal wave and both the background and the abnormal wave was 23.5%; the normal EEG in the VaD group was 6.4%, only the background change was 10.6%, only the abnormal wave was 14.9%, and the EEG with both the background and the abnormal wave changed was 68.1%. There was statistical significance between the two groups (P0.05). The EEG of the non-abnormal wave in the 81 subjects was 32.1%, the EEG of the small abnormal wave was 27.2%, the EEG of the abnormal wave was 30.9%, and the EEG of the large number of abnormal waves was 9.9%. Of these, the VCIND groups were 52.9%, 32.4%, 14.7%, and 0.0%, respectively. The corresponding VaD groups were 17.0%, 23.4%, 42.7% and 17.0%, respectively. There was a significant difference between the two groups (P0.01).6. In comparison with the general characteristics of the EEG in the VCIND group and the VaD group, the frequency of the brain electrical background in the VaD group was slower, the background brain power and the focal slow wave activity increased, the rhythm was generalized, the proportion of the amplitude modulation abnormality and the abnormal wave was increased, and the statistical significance (P0.05). The corresponding MMSE scores between normal EEG, mild abnormal EEG, moderate and severe abnormal EEG4 groups (23.89, 4.137 vs. 22.15, 5.936 vs. 21.64, 5.480 vs. 14.43, 4.577), and Mo CA scores (18.78, 5.333 vs. 16.58, 5.907 vs. 15.36, 5.603 vs. 8.57, 1.272), The scores of MES (63.14-17.790 vs 56.50-23.376 vs. 54.57-22.909 vs. 33.00-14.434) and ADL (26.22-6.037 vs. 30.46-13.252 vs. 31.36-12.592 vs. 47.43-15.757) were statistically different (P0.05). MMSE (24.65-4.039 vs. 22.05-5.481 vs. 19.88-5.630 vs. 14.13-4.324) MOCA (18.69-4.488 vs 15.82-5.395 vs 14.24-6.112 vs. 8.63-3.159), MES (66.23-16.535 vs. 57.42-20.868 vs. 46.33-24.259 vs. 34.38-17.808), with no abnormal wave, small, medium and large number of abnormal waves. The scores of ADL (26.00-5.987 vs 29.95-13.415 vs 35.08-13.687 vs. 46.38-17.533) were statistically different (P0.05). Conclusion:1. With the development of the disease, the performance, memory function and language ability of the CVCI patients are impaired. The increase in the proportion of abnormal EEG was also increased. That is, the EEG has a high sensitivity to the diagnosis of CVCI and can reflect the progress of cognitive dysfunction.3. The change of the EEG in the CVCI patients can be the change of the background, the focal abnormal wave or the combined existence, the background of the VCIND changes to the main form, and when the degree of cognitive impairment is further increased, 4. With the increase of the degree of cognitive impairment, the background frequency of the EEG is slow, the background of the brain and the focal slow wave are increased, the rhythm is generalized, the regulation of the amplitude modulation and the proportion of the focal abnormal wave are also increased. There may be a small, medium or large number of abnormal waves in the EEG focal change of the CVCI patients, with a small amount and a moderate amount of change. With the increase of the degree of cognitive impairment, the proportion of EEG in the middle and the large number of abnormal waves was increased.6, The degree of abnormal EEG and the number of abnormal waves were related to the cognitive scale and the ability of daily life.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.13

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