轻度认知功能障碍患者空间导航能力相关的结构基础研究

发布时间：2018-04-30 14:45

  本文选题：空间导航能力 + 轻度认知功能障碍　； 参考：《南京大学》2017年硕士论文

【摘要】：第一部分轻度认知障碍患者空间导航能力相关的脑白质完整性改变目的:采用基于纤维束空间统计分析方法(Tract-Based Spatial Statistics,TBSS)探索轻度认知障碍(Mild cognitive impairment,MCI)患者脑白质完整性改变,并与其空间导航能力进行相关性分析,以期揭示MCI患者空间导航障碍的白质改变的微观结构基础。方法:病例组来自南京大学医学院附属鼓楼医院的神经内科门诊以认知障碍为主诉的患者,其中诊断为MCI的患者27例,时间为2015年5月到2016年2月,然后通过社区招募正常认知对照组(Normal Control,NC),共24例,其性别、年龄以及受教育程度与病例组无统计学差异。所有被试均进行了计算机模拟空间导航能力测试以及3.0T头颅MRI弥散张量成像(Diffusion Tensor Imaging,DTI)扫描,然后采用PANDA软件对原始数据进行预处理,之后采用TBSS对受试者的部分各向异性(FractionalAnisotropy,FA)图进行全脑非参数统计的比较,以及纤维束FA值与空间导航能力的相关性分析。结果:与NC组相比,MCI组的混合(环境+自我)导航、自我导航及环境导航能力均有下降,其中自我导航能力减退达到统计学差异(t=-2.202,p0.05)。MCI患者FA值减低的纤维束主要位于双侧上纵束(左侧t=2.950,右侧t=2.950,p0.05)、双侧下纵束(左侧 t=2.660,右侧 t=2.960,p0.05),胼胝体束(t=2.090,p0.05)及双侧扣带束(左侧 t=2.760,右侧 t=2.410,p0.05),穹窿(t=4.830,p0.05),双侧皮质脊髓束(左侧t=2.330,右侧t=2.260,p0.05)。其中,双侧下纵束(左侧 r=-0.338,右侧 r=-0.336,p0.05)、双侧上纵束(左 r=-0.354,右 r=-0.347,p0.05)、右侧皮质脊髓束(r=-0.362,p0.05)和穹隆束(r=-0.369,p0.05)以及扣带束(左r=-0.395,右r=-0.370,p0.05)的FA值与自我导航平均误差距离呈负相关关系。环境导航的平均误差距离与双侧上纵束(左r=-0.329,右r=-0.350,p0.05)、双侧下纵束(左r=-0.349,右r=-0.378,p0.05)、双侧扣带束(左r=-0.340,右r=-0.406,p0.05)及胼胝体束压部(r=-0.364,p0.05)的FA值呈明显负相关关系。结论:本研究通过分析脑白质纤维束FA值和空间导航障碍的相关性,证实了白质微观结构的改变与MCI患者的空间导航能力障碍有一定的关联,进而对日后深入探究有关人类空间导航能力的神经生物学机制奠定了相关基础。第二部分轻度认知障碍患者空间导航能力相关的皮质下核团体积研究目的:探讨轻度认知障碍(Mild cognitive impairment,MCI)患者皮质下核团体积改变的规律,及其与空间导航能力之间的关系,以期揭示MCI患者空间导航障碍的皮层下核团改变的结构基础。方法:选取2016年1月-2016年10月在南京大学医学院附属鼓楼医院神经内科就诊的30例MCI患者和年龄、性别、受教育程度匹配的28例正常认知对照组(Normal Control,NC)进行头颅MRI扫描,采用计算机模拟空间导航系统测试所有被试的空间导航能力。用FreeSurfer 5.3.0软件对3D T1WI MRI图像进行结构分割,软件自动计算出双侧丘脑、尾状核、壳核、海马、苍白球、伏隔核和杏仁体等皮质下核团的体积。然后采用偏相关统计方法来分析被试各皮层下核团体积与空间导航能力行为学评分的关系。结果:与NC相比较,MCI组患者的所有核团体积有轻微萎缩,但没有达到统计学差异。MCI组患者在控制年龄、性别、教育程度及全脑体积后,左侧苍白核体积(r=-0.284,p=0.034)和左侧海马体积(r=-0.265,p=0.048)与混合导航(环境及自我)平均误差距离负相关,提示左侧苍白核体积和左侧海马体积越小,混合(环境及自我)导航能力越差;环境导航平均误差距离与左侧壳核体积(r=-0.305,p=0.022)具有负相关关系,提示左侧壳核体积体积越小,环境导航能力越差。结论:本研究揭示了 MCI患者皮层下核团体积与空间导航能力的关系,丰富了相关的空间导航能力结构基础的研究,对进一步研究空间导航障碍发生的机制有重要价值。
[Abstract]:The first part of the patients with mild cognitive impairment (Tract-Based Spatial Statistics, TBSS) was used to explore the white matter integrity changes in patients with mild cognitive impairment (Mild cognitive impairment, MCI) based on the spatial navigation ability of patients with mild cognitive impairment and to explore the spatial navigation ability of patients with mild cognitive impairment (Mild cognitive impairment, MCI). In order to reveal the microstructural basis of the white matter changes in MCI patients with spatial navigation disorders, the case group came from the neurology outpatient department of the Drum Tower Hospital Affiliated to the Nanjing University Medical College, who was diagnosed with cognitive impairment, of which 27 patients were diagnosed with MCI, from May 2015 to February 2016, and then recruited through community recruitment. The normal cognitive control group (Normal Control, NC), with a total of 24 cases, had no statistical difference between the sex, age, and the degree of education and the case group. All subjects performed the computer simulation space navigation ability test and the 3.0T head MRI diffusion tensor imaging (Diffusion Tensor Imaging, DTI) scan, and then used PANDA software to carry out the original data. Preprocessing, then using TBSS to compare the nonparametric statistics of the whole brain with the partial anisotropy (FractionalAnisotropy, FA) diagram of the subjects, and the correlation analysis of the fiber bundle FA value and the spatial navigation ability. Results: compared with the NC group, the mixed (environment + self) navigation, self navigation and environmental navigation ability of the MCI group have decreased. The t=-2.202 (P0.05).MCI patients with decreased FA value were mainly located in the bilateral superior longitudinal fascicles (left t=2.950, right t=2.950, P0.05), bilateral inferior longitudinal fascicles (left t=2.660, right t=2.960, P0.05), corpus callosum (t=2.090, P0.05) and bilateral cingulate tract (left side, right side), and dome 4.830, P0.05), bilateral corticospinal tract (left t=2.330, right t=2.260, P0.05). Among them, bilateral inferior longitudinal fascicles (left r=-0.338, right r=-0.336, P0.05), bilateral superior longitudinal fasciculus (left r=-0.354, right r=-0.347, P0.05), right corticospinal tract (r=-0.362, P0.05) and dome bundle The mean error distance of the navigation is negatively correlated with the distance between the average error distance of the environment navigation and the bilateral upper longitudinal beam (left r=-0.329, right r=-0.350, P0.05), bilateral lower longitudinal fasciculus (left r=-0.349, right r=-0.378, P0.05), bilateral cingulate bundle (left r=-0.340, right r=-0.406, P0.05) and the corpus callosum pressure (r=-0.364, P0.05). Conclusion: by analyzing the correlation between the FA value of the white matter fiber bundle and the spatial navigation disorder, this study confirms that the changes of the white matter microstructures are related to the spatial navigation ability of MCI patients, and then lay the foundation for the further exploration of the neurobiological mechanism of human spatial navigation ability in the future. Second parts Study on the volume of subcortical nuclei associated with spatial navigation ability in patients with mild cognitive impairment Objective: To explore the changes in the volume of subcortical nuclei in patients with Mild cognitive impairment (MCI) and the relationship between the subcortical nuclei and their spatial navigation ability in order to reveal the structure of subcortical nuclei changes in MCI patients with spatial navigation disorders. Methods: 30 patients with MCI in the Department of Neurology, affiliated to Drum Tower Hospital Affiliated to Nanjing University Medical College, January 2016 -2016 years, and 28 cases of normal cognitive control group (Normal Control, NC) matched for age, sex and educational level were scanned for head MRI, and the space navigation system of computer simulated space navigation system was used to test the space guide of all the subjects. FreeSurfer 5.3.0 software is used to divide the structure of 3D T1WI MRI images. The software automatically calculates the volume of the subcortical nuclei of bilateral thalamus, caudate nucleus, putamen, hippocampus, globus pallidus, nucleus accumbens and amygdala. Then the statistical method of partial correlation is used to analyze the behavior score of the volume and space navigation ability of the subcortical nuclei of the subjects. Results: compared with NC, the volume of all the nuclei in the MCI group had a slight atrophy, but there was no statistical difference in the control age, sex, education and total brain volume in group.MCI, and the left pallid nucleus volume (r=-0.284, p=0.034) and the left hippocampal volume (r=-0.265, p=0.048) and the average error of mixed navigation (environment and self). The negative correlation of difference distance suggests that the smaller the volume of the left pallid nucleus and the smaller the volume of the left hippocampus, the worse the mixing (environment and self) navigation ability; the negative correlation between the average error distance of the environmental navigation and the r=-0.305 (p=0.022) of the left putamen, which suggests that the smaller the volume of the left shell nucleus is, the worse the environmental navigation ability is. Conclusion: This study reveals the MCI The relationship between the volume of subcortical nuclei and the spatial navigation ability of the patients enriches the research on the basis of the spatial navigation ability structure, which is of great value to the further study of the mechanism of the spatial navigation obstacle.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1
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本文编号：1824974