不同亚型轻度认知功能损害的认知特征和磁共振波谱研究

发布时间：2018-02-27 21:25

本文关键词： 轻度认知功能损害神经心理学磁共振波谱　出处：《安徽医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的采用神经心理学量表，探讨不同亚型轻度认知功能损害（MCI）的神经心理学特征；应用氢质子磁共振波谱技术（1H MRS），揭示不同亚型MCI颅内代谢改变的特点，以及1H MRS代谢指标与认知损害之间的关系，进一步探讨1H MRS在不同亚型MCI鉴别诊断中的意义。方法采用一系列神经心理学量表检查，包括简易智能状态量表（MMSE）、剑桥老年认知检查量表中文版（CAMCOG-C）、老年抑郁自评量表（GDS）等，比较遗忘型MCI（A-MCI）、血管型MCI(V-MCI)及帕金森病型MCI（PD-MCI）的神经心理学特征。对14例A-MCI、12例V-MCI及17例认知功能正常老年人进行单体素1H MRS检查，磁共振设备选择GE公司的Signa3.0T超导磁共振，兴趣区在优势半球的额叶、基底节区及海马，通过对各兴趣区波谱信号的采集，最终系统自动以Cr为内参给出各代谢指标的比值，包括NAA/Cr、Cho/Cr及MI/Cr。比较A-MCI与V-MCI患者1H MRS代谢指标改变的不同及其代谢指标与认知之间的相关性。结果（1）研究对象各组年龄、性别及受教育程度方面均无统计学意义，A-MCI与V-MCI组高血压患病率显著增高。（2）A-MCI、V-MCI及PD-MCI均在多个认知区域受损，其中A-MCI组以近记忆、学习记忆及计算受损突出，V-MCI组运用功能受损明显，PD-MCI的认知损害最为广泛，除近记忆、学习记忆受损外，远记忆功能及运用功能均显著受损，，与A-MCI及V-MCI组比较均有统计学意义。A-MCI组GDS评分较正常对照组显著增高。（3）V-MCI组左侧额叶NAA/Cr比值较对照组及A-MCI组显著降低，NAA/Cr降低水平与CAMCOG-C总体得分、定向、语言理解及运用均呈显著正相关。A-MCI组在左侧海马NAA/Cr比值显著降低，与V-MCI组及对照组相比均有统计学意义，与该组的近记忆得分显著正相关。三组在左侧基底区各项代谢指标均无显著改变。结论（1）A-MCI、V-MCI与PD-MCI认知损害均为多区域性，A-MCI主要表现为记忆损害，V-MCI以执行功能损害为主，PD-MCI记忆及执行功能均受损。A-MCI较其他亚型更易出现抑郁倾向。（2）1H MRS可以将A-MCI或V-MCI与正常老年人相鉴别，海马与额叶的NAA/Cr比值能分别较好的反映A-MCI与V-MCI认知损害的程度。1H MRS可能是鉴别A-MCI与V-MCI的有效工具之一。
[Abstract]:Objective to explore the neuropsychological characteristics of mild cognitive impairment (MCI) in different subtypes of MCI by using neuropsychological scale, and to reveal the characteristics of intracranial metabolic changes in different subtypes of MCI by using 1H Mr spectroscopy. And the relationship between 1H MRS metabolic index and cognitive impairment, and the significance of 1H MRS in differential diagnosis of different MCI subtypes. Methods A series of neuropsychological scales were used, including simple Mental State scale (MMSEN), Cambridge Cognitive scale for the elderly (CAMCOG-CU), Self-Rating Depression scale for the elderly (GDSs) and so on. To compare the neuropsychological characteristics of amnesia type MCI A-MCI, vascular type MCIV MCI and Parkinson's disease MCII PD-MCI. Monomers 1H MRS were examined in 14 patients with A-MCI, 12 patients with V-MCI and 17 elderly patients with cognitive function. The magnetic resonance equipment was GE Signa3.0T superconducting magnetic resonance (Mr). The region of interest is in the frontal lobe, basal ganglia and hippocampus of the dominant hemispheres. By collecting the spectral signals of each region of interest, the system automatically uses Cr as the internal reference to give the ratio of each metabolic index. The changes of 1H MRS metabolic indexes in A-MCI and V-MCI patients were compared, and the correlation between metabolic indexes and cognition was compared between A-MCI patients and V-MCI patients. Results (1) there was no significant difference in age, sex and education level between A-MCI group and V-MCI group. The prevalence of hypertension in A-MCI group and V-MCI group was significantly higher than that in A-MCI group. Both V-MCI and PD-MCI were damaged in multiple cognitive regions, among which A-MCI group had near memory. In the V-MCI group, the cognitive impairment of PD-MCI was the most extensive. In addition to the impairment of near memory and learning memory, the function of distant memory and application were all significantly impaired. Compared with A-MCI group and V-MCI group, the GDS score of A-MCI group was significantly higher than that of normal control group. The NAA/Cr ratio of left frontal lobe in A-MCI group was significantly lower than that in control group and A-MCI group. The ratio of NAA/Cr in left hippocampus was significantly decreased in A-MCI group compared with V-MCI group and control group. There was no significant change in all metabolic indexes in the left basal area in the three groups. Conclusion both A-MCICI and PD-MCI cognitive impairment are multi-regional. The main manifestation of A-MCI is memory impairment. Both memory and executive function are impaired. A-MCI is more likely to develop depression tendency than other subtypes. A-MCI or V-MCI can be associated with A-MCI or V-MCI. The normal old people are distinguished from each other. The ratio of NAA/Cr in hippocampus to frontal lobe can reflect the degree of cognitive impairment between A-MCI and V-MCI. 1H MRS may be one of the effective tools to distinguish A-MCI from V-MCI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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