认知功能障碍患者步态障碍的临床相关性研究

发布时间：2018-02-21 00:51

本文关键词： 轻度认知功能障碍步态障碍神经心理评估步态障碍评估　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究上海交通大学医学院附属新华医院神经内科认知功能障碍(Cognitive Impairment,CI)患者的神经心理学特点及其与步态障碍的相关性,并进一步分析步态障碍是否可作为早期认知功能下降的一个临床标志。方法:分别对30名正常对照组、29名轻度认知功能障碍患者(MCI)、21名阿尔茨海默病患者(AD)进行神经心理学测试:简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo CA)、Addenbrooke改良认知评估量表(ACE-R)、连线试验(TMT-A)、数字广度测验(DST);步态平衡测试(5次坐立试验、3米行走试验TUG、Berg平衡量表)及日常生活能力问卷(ADL)等。采用独立样本t检验、卡方检验、非参数检验、相关性分析等对各项数据进行统计。结果:1)与正常对照组相比,MCI和AD患者均存在步态障碍(P0.05),但MCI与AD患者的步态障碍无统计学差异,提示步态障碍可能是轻度认知功能障碍的早期标志,步态障碍并不随认知功能加重下降。2)步行速度与注意力(P=0.000)、视空间(P=0.022)、执行功能(P=0.003)、长时记忆(P=0.034)呈正相关。平衡功能与注意力(P=0.004)、记忆力(P=0.002)、语言流利性(P=0.002)呈正相关。3)考虑步态障碍可能是轻度认知功能障碍的早期标志,因此对其进行ROC统计提示曲线下面积为0.872,表明步行缓慢、步行时间延长对于认知功能下降具有良好的预测效能,并得出最佳诊断分界点为8.855s。即3米起立步行试验时间大于8.855s时提示患者可能存在认知功能下降。结论:认知功能障碍患者存在步态障碍(平衡障碍、稳定性差、协调性差、步行速度减慢)。步态障碍可能是早期认知功能下降的一个标志,长期随访更有利于痴呆患者早期诊断及治疗。
[Abstract]:Objective: to study the characteristics of neuropsychology in patients with cognitive dysfunction in Department of Neurology, Xinhua Hospital affiliated to Shanghai Jiaotong University, and its correlation with gait disorders. To further analyze whether gait disorder can be used as a clinical marker of early cognitive impairment. Methods: 29 patients with mild cognitive impairment in 30 normal controls were treated with adriamycin (ADG) in 21 patients with Alzheimer's disease (AD). Psychological tests: simple Mental State scale (MMSEN), Montreal Cognitive Assessment scale (MMS), Montreal Cognitive Assessment scale (Montreal), Addenbrooke modified Cognitive Assessment scale (ACE-RV), Linkage Test (TMT-An), digit Span Test (DSTT); gait balance Test (5 times) with sitting and standing test (3 m walking test). TUGG Berg balance scale and ADL) were used. T test of independent sample was used. Results: compared with the normal control group, the patients with MCI and AD had gait disorders (P0.05), but there was no significant difference in gait disorders between MCI and AD patients. It suggests that gait disorder may be an early sign of mild cognitive impairment. Gait dysfunction does not decrease with cognitive function. 2) walking speed is positively correlated with attention, visual space, executive function, long term memory, and P0. 034). Balance function is positively correlated with attention, memory, language fluency, and language fluency. Gait disorders may be an early sign of mild cognitive impairment, Therefore, the area under the curve of ROC statistical indication was 0.872, which indicated that slow walking and prolonged walking time had a good predictive effect on cognitive impairment. The best diagnostic boundary point is 8.855 s. When the time of 3-meter standing walking test is longer than 8.855 s, the patients may have cognitive dysfunction. Conclusion: the patients with cognitive dysfunction have gait disorders (balance disorder, poor stability, poor coordination). Gait dysfunction may be a marker of early cognitive decline, and long term follow-up is more helpful for early diagnosis and treatment of dementia patients.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749

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