孤立性侧脑室后角旁白质疏松对认知功能的影响及其神经心理特征

发布时间：2018-04-24 20:04

本文选题：脑白质疏松 + 侧脑室后角旁白质疏松　；参考：《第三军医大学》2017年硕士论文

【摘要】：背景及目的随着颅脑计算机断层扫描(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)的广泛应用,脑白质疏松(leukoaraiosis,LA)越来越多地在中、老年人中被发现。目前大量研究表明脑白质疏松与认知功能损害相关,无论是直接导致认知损害还是由皮质萎缩所介导,普遍认为是血管性痴呆和阿兹海默病的独立性危险因素。但是,早期局部脑白质(孤立性半卵圆区、侧脑室前角旁、后角旁或室体旁白质疏松)是否对认知功能造成损害,以及不同部位脑白质疏松造成的认知损害特点仍然不十分清楚,故本研究筛选临床上常见的、早期的、局灶性白质疏松,孤立性侧脑室后角旁白质疏松(occipital periventricular leukoaraiosis,OPVL)受试者为研究对象,探讨其对认知功能的影响及其神经心理特征,以期据此初步提出脑白质疏松相关认知功能损害的神经心理重点测评指标和测评方案,以及与其他明确病因引起的认知功能损害的鉴别诊断,从而为早期干预提供依据。方法采用病例对照研究,纳入符合标准的第三军医大学新桥医院神经内科病例。通过颅脑MRI检查结果筛选出仅有侧脑室后角旁3~13 mm范围损害的孤立性侧脑室后角旁白质疏松受试者30例为后角组(posterior horn group,PHG)、大脑半球多部位存在脑白质疏松的受试者32例作为混合组(mixed grou,MG)以及经颅脑MRI证实无脑实质结构性改变的受试者33例作为对照组(controls,CN),三组受试者在人口统计学、脑血管病主要危险因素等一般临床资料相匹配。对三组受试者分别行神经心理量表测评。使用简易精神状态量表(mini-mental state examination,MMSE)和蒙特利尔认知评估量表(Montreal cognitive assessment,Mo CA北京版)评价受试者总体认知功能数字广度测验(digit span test,DST)评估注意能力。临床记忆量表(clinical memory scale,CMS甲式)评估记忆能力。对比分析侧脑室后角旁白质疏松对认知功能的影响及其神经心理学特征。结果后角组与对照组相比,后角组的MMSE和MoCA总分较低(P0.01),短时记忆、延迟记忆、指向记忆、定向力和语言能力单项评分也明显降低(P0.05,P0.01),而其他方面认知单项评分差异无统计学意义(P0.05)。混合组与对照组相比,MMSE和MoCA总分较低(P0.01),记忆力、定向力、语言能力、注意力、视觉空间与执行和抽象认知单项评分也明显降低(P0.05,P0.01)。后角组与混合组相比,后角组抽象认知、延迟记忆力、图像自由回忆和人像特点联系回忆评分显著较高(P0.05,P0.01),其他认知方面单项评分差异无统计学意义(P0.05)。结论孤立性侧脑室后角旁白质疏松导致以定向力、记忆力和语言能力减退为特征的认知功能损害。
[Abstract]:Background and objective with the wide application of computed tomographic CT (CT) and magnetic resonance imaging (MRI), leukoaraiosisla (leukoaraiosisla) is more and more common in the aged. At present, a large number of studies have shown that leukoaraiosis is associated with cognitive impairment, whether directly resulting in cognitive impairment or mediated by cortical atrophy. It is generally considered as an independent risk factor for vascular dementia and Alzheimer's disease. However, whether the early local white matter (solitary semicircular area, paraventricular anterior horn, posterior horn or paraventricular leukoaraiosis) has impaired cognitive function, And the characteristics of cognitive impairment caused by leukoaraiosis in different parts of the brain are still unclear, so this study screening common clinical, early, focal leukoaraiosis, The subjects of isolated parietal periventricular leukoaraiosissis OPVL in the posterior horn of the lateral ventricle were studied to investigate their effects on cognitive function and neuropsychological characteristics. In order to put forward the key neuropsychological evaluation index and evaluation scheme of cognitive impairment related to leukoaraiosis, and the differential diagnosis of cognitive impairment caused by other definite etiology, so as to provide the basis for early intervention. Methods A case-control study was carried out in the Department of Neurology, Xinqiao Hospital, third military Medical University. According to the results of craniocerebral MRI examination, 30 subjects with isolated lateral ventricular posterior horn leukoaraiosis were selected as posterior horn group PHG, and white matter osteoporosis was found in many parts of the cerebral hemispheres. The results of brain MRI examination showed that 30 subjects with isolated lateral ventricular posterior horn leukoaraiosis had only 3 mm damage in the posterior horn of the lateral ventricle. There were 32 cases as mixed group and 33 cases as control group with structural changes of brain parenchyma confirmed by craniocerebral MRI. The main risk factors of cerebrovascular disease were matched with other general clinical data. Three groups of subjects were assessed with neuropsychological scale. The mini-mental state examination (MMSE) and the Montreal cognitive assessment (MMSE) were used to evaluate the attention ability of the subjects using the digit span test of total cognitive function (digit span test). Clinical memory scale was used to evaluate memory ability. The effects of leukoaraiosis in the posterior horn of lateral ventricle on cognitive function and its neuropsychological characteristics were analyzed. Results compared with the control group, the total scores of MMSE and MoCA in the posterior horn group were lower than those in the control group, and the scores of short-term memory, delayed memory, directed memory, directional ability and language ability were significantly lower than those in the control group, but there was no significant difference in other cognitive individual scores. Compared with the control group, the total scores of MMSE and MoCA in the mixed group were significantly lower than those in the control group (P 0.01). The scores of memory, orientation, language ability, attention, visual space and executive and abstract cognitive items were also significantly lower than those in the control group (P 0.05 and P 0.01). In the posterior horn group, the scores of abstract cognition, delayed memory, image free recall and the associative recall of human image characteristics were significantly higher than those in the mixed group, but there was no significant difference in other cognitive individual scores (P 0.05). Conclusion isolated leukoaraiosis in the posterior horn of the lateral ventricle leads to cognitive impairment characterized by decreased orientation, memory and language ability.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1

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