非关键部位缺血性卒中急性期认知功能障碍特点的研究

发布时间：2018-05-10 13:48

本文选题：血管性认知功能障碍 + 缺血性卒中　；参考：《南方医科大学》2013年硕士论文

【摘要】：研究背景及目的：随着中国的人口老年化,与年龄相关的疾病如痴呆的发生率也逐年攀升。血管性痴呆作为痴呆的第二大常见病因,也逐渐受到人们重视。血管性认知功能障碍的评估需要涉及每一个认知领域。直接造成血管性认知功能障碍或痴呆的病理类型有五类：多梗死型,关键部位梗死型,腔梗或腔梗状态,Binswanger综合征和其他类型(包括海马硬化、分水岭梗死)。对于关键部位梗死的认知功能特点已经早有研究,而很少有关于非关键部位梗死的认知功能特点的研究,因此本文将研究非关键部位梗死急性期的认知功能特点,特别是血管性认知功能障碍非痴呆期的认知障碍特点,研究成果将对血管性认知功能障碍的诊断及鉴别诊断有重要意义。方法：收集2012年6月至2012年12月之间在本院神经内科住院的首次诊断为缺血性卒中患者的临床和神经心理学评估资料。实验组(卒中组)42例,对照组20例,由经过统一培训的神经内科医生评估患者及健康成人的认知功能,评估项目如下：简易精神状态评估量表,Rey听力词语学习测验中文版评估其词语记忆功能,Rey复杂图形评估其视空间记忆功能,Stroop字色干扰测试、连线试验A和B、韦氏数字符号测验、语义流畅性测验表示其执行功能。语义流畅性测验同时也可评估患者的语言功能。根据Z分将实验组又分为VCI组和VNC组。结果：实验组总共40例完成认知功能评估,总体认知功能的评估中,实验组总体认知功能较对照组差。记忆功能方面,实验组词语延迟回忆功能、视空记忆功能较对照组差；而词语瞬时记忆功能和短时记忆功能的差异无统计学意义。执行功能方面,实验组精神灵活性、抗干扰能力较差,而信息处理速度和推理转换能力的差异无统计学意义。相关分析中,记忆功能与执行功能存在直线相关关系。实验组可分为VCI组19例(47.5%)和VNC组21例(52.5%)。实验组中,15%的患者存在视空间功能障碍,15%存在视空间记忆障碍；20%存在词语记忆功能障碍,其中10%存在短时词语记忆障碍,12.5%存在短延迟记忆障碍,20%存在长延迟记忆障碍；12.5%存在语言功能障碍；30%存在执行功能障碍,其中12.5%存在精神灵活性障碍,10%存在推理转换能力障碍,17.5%存在信息处理速度异常,10%存在抗干扰能力异常。结论：在排除了关键部位梗死和中到重度脑白质变性后,我们发现47.5%的非关键部位缺血性卒中(大动脉粥样硬化型)急性期患者存在认知功能障碍,此类患者的词语记忆功能、视空间功能、视空间记忆功能、执行功能及语言功能障碍的发生率波动在10-30%,并以执行功能障碍为主要表现。记忆功能障碍以长延迟回忆功能障碍为主,说明患者存在对信息的提取及再现功能异常,而对信息储存功能相对正常。记忆功能障碍可能继发于执行功能障碍,而阿尔茨海默病则主要表现为以情景记忆障碍为主的信息储存功能障碍,而信息提取及再现功能相对保留,因此这一特点有助于鉴别处于血管性认知功能障碍非痴呆期的患者是否合并阿尔茨海默病。
[Abstract]:Background and Objective : With the aging of Chinese population , the incidence of vascular dementia is increasing year by year . Vascular dementia is a second major common disease of dementia . Vascular dementia needs to be involved in every cognitive field . The pathological types of vascular cognitive dysfunction or dementia are five types : multi - infarct , infarction type in key part , myocardial infarction , lacunar infarction , Binswanger syndrome and other types ( including hippocampus sclerosis , watershed infarction ) . The cognitive function of infarction in key parts has been studied early , and there are few studies on the cognitive function characteristics of non - critical part infarction . Therefore , this paper will study the cognitive function characteristics of non - critical part infarction in the acute stage , especially the cognitive impairment characteristics of non - dementia period of vascular cognitive impairment , and the research results will be of great significance to the diagnosis and differential diagnosis of vascular cognitive impairment .

Methods : The clinical and neuropsychological assessment data of patients with ischemic stroke were collected from June 2012 to December 2012 . In the experimental group ( stroke group ) 42 cases and control group ( n = 20 ) , the cognitive function of patients and healthy adults was assessed by a unified trained neurologist .

Results : A total of 40 patients in the experimental group completed the cognitive function assessment , and the overall cognitive function of the experimental group was worse than that of the control group .
In the experimental group , there were 19 cases of VCI group ( 47.5 % ) and 21 cases ( 52.5 % ) in the control group . In the experimental group , 15 % of the patients had visual spatial dysfunction and 15 % had spatial memory impairment .
20 % had word memory dysfunction , 10 % had short term memory impairment , 12.5 % had short delay memory impairment , 20 % had long delay memory impairment ;
12.5 % have language dysfunction ;
There were executive dysfunction in 30 % , of which 12.5 % had mental flexibility barriers , 10 % had an impairment of reasoning ability , 17.5 % had information processing speed exception , 10 % had an abnormality of anti - interference ability .

Conclusion : We found that 47.5 % of patients with acute stage ischemic stroke ( atherosclerotic type ) had cognitive impairment after eliminating the key site infarction and middle - to - severe brain white matter degeneration .

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3

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