阿尔茨海默病与散发型脑小血管病认知功能障碍的差异性比较

发布时间：2018-05-29 22:33

本文选题：AD + 散发型CSVD　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景和目的认知功能障碍泛指各种原因导致的不同程度的认知功能损害。临床上导致认知功能障碍的疾病繁多,阿尔茨海默病(Alzheimer's disease,AD)和散发型脑小血管病(sporadic cerebral small disease,sporadic CSVD)是导致认知功能障碍的常见类型。这两种疾病均具有慢性进行性认知功能障碍、功能退化和行为异常等精神症状。高血压、糖尿病、肥胖、高脂血症等是散发型CSVD的血管因素,也常出现在AD患者中。人们对二者认知功能的研究众多,作者通过文弩献阅读发现二者所致的认知功能障碍在不同认知域有着不同的表现。本研究旨在比较AD及散发型CSVD所致的认知障碍在不同认知域中的差异性。材料与方法1.研究对象研究对象来源于2015.01-2017.01就诊于山东大学齐鲁医院神经内科门诊及病房的AD及散发型CSVD患者,收集患者一般资料、血液学检查、简易智能精神状态检查量表(mini-mental state examination,MMSE)及蒙特利尔认知评估量表中文版(Montreal cognitive assessment scale,MoCA)评分。筛选出"很可能AD"组(AD组),"散发型CSVD"组(CSVD组),及同期正常对照组(Con组)人员,并对AD与散发型CSVD认知功能障碍的差异性进行分析。2.研究方法收集受试者相关病史,包括患者年龄、性别、受教育程度、吸烟、饮酒史以及高血压、糖尿病、高脂血症、高同型半胱氨酸血症,对AD及散发型CSVD的危险因素进行分析。根据MMSE及MoCA评分,对受试者定向力、即刻回忆、注意力、计算力、延迟回忆、语言、抽象能力、视空间觉及执行能力进行分析。3.数据分析采用SPSS22.0数据软件对数据进行统计学分析。其中,计量资料通过卡方检验进行两两比较,计数资料通过非参数检验进行两两比较。检验水平均为0.05。P0.05表示具有显著性差异。结果1.一般资料本研究共纳入"AD组"患者43例,"CSVD组"患者45例,"Con组"人员46例。各组在性别、教育年限、高脂血症、高同型半胱氨酸血症(高Hcy)、吸烟史、饮酒史上无统计学差异。CSVD组年龄、高血压与糖尿病的患病率高于AD组及Con组。2.MMSE总分及子项目AD组与Con组相比,在MMSE总分、定向力、注意力与计算力、延迟回忆、书写及视空间觉上有统计学差异,而在即刻回忆、命名、复述、阅读及理解上无显著性差异(见表2)。CSVD组与Con组相比,在MMSE总分、定向力、即刻记忆、注意力与计算力、延迟回忆、复述、理解、书写及视空间觉上有统计学差异,而在命名与阅读上则无统计学差异(见表3)。AD组与CSVD组相比,在定向力、注意力与计算力、及复述上存在统计学差异,而在MMSE总分、即刻记忆、延迟回忆、命名、阅读、理解、书写及视空间觉上无统计学差异(见表4)。3.MoCA总分及子项目AD组与Con组相比,在除命名与顺背外所有的MoCA子项目中均具有明显差异性(见表5)。CSVD组与Con组相比,在所有的MoCA子项目中均具有明显差异性(见表6)。AD组与CSVD组相比,在MoCA总分、即刻回忆、复制立方体、画钟试验、倒背、注意力、词语流畅性、抽象及定向力上具有统计学差异,而在连线试验、命名、顺背、计算力、复述及延迟回忆上无统计学差异(见表7)。结论1、与AD相比,散发型CSVD所致认知功能障碍与年龄、高血压及糖尿病的关系更为密切。2、与AD相比,散发型CSVD所致的认知功能障碍累及的认知域更为广泛;MoCA的得分也更低,说明MoCA在评估散发型CSVD认知功能的敏感性高于MMSE。3、与AD相比,散发型CSVD所致的认知功能障碍在命名、复述及自由回忆上的表现无差异;散发型CSVD在即刻记忆、计算力与注意力、词语流畅性、f抽象思维和执行功能领域上的损害更重,而在定向力上的表现明显优于AD。
[Abstract]:Background and objective cognitive dysfunction generally refers to the varying degrees of cognitive impairment caused by various causes. There are many clinical causes of cognitive impairment. Alzheimer's disease (AD) and diffuse cerebral small vascular disease (sporadic cerebral small disease, sporadic CSVD) are the common causes of cognitive dysfunction. These two diseases all have mental symptoms such as chronic progressive cognitive impairment, functional degeneration and abnormal behavior. Hypertension, diabetes, obesity, hyperlipidemia, etc. are the vascular factors of the scattered CSVD, and often appear in the patients with AD. The study of the cognitive function of the two persons is numerous, and the author finds two through the reading of the literary crossbow. Cognitive impairment was different in different cognitive domains. The purpose of this study was to compare the differences of cognitive impairment caused by AD and scattered CSVD in different cognitive domains. Material and methods 1. subjects were derived from the AD and distribution of 2015.01-2017.01 in the neurology clinic and ward of Qilu Hospital of Shandong University. Type CSVD patients were collected for general data, hematology, Mini-Mental State Examination (MMSE) and the Chinese version of the Montreal cognitive assessment scale (Montreal cognitive assessment scale, MoCA). An analysis of the differences in the cognitive impairment between AD and diffuse CSVD in the group (group Con) and the analysis of the related history of patients with.2. research, including age, sex, education, smoking, drinking history, hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, and risk factors for AD and scattered CSVD. According to the MMSE and MoCA scores, the subjects' orientation, immediate memory, attention, computational power, delayed memory, language, abstract ability, visual spatial awareness and execution ability were analyzed for statistical analysis of.3. data using SPSS22.0 data software. Among them, the measurement data were compared by chi square test for 22 comparison, counting data 22 comparisons were made by nonparametric tests. The level of test was 0.05.P0.05. Results 1. general data included 43 cases of "group AD", 45 cases in group CSVD, and 46 cases of "group Con". All groups were in sex, years of education, hyperlipidemia, hyperhomocysteinemia (high Hcy), smoking history, and drinking history. Statistical difference in group.CSVD age, the prevalence of hypertension and diabetes was higher than that in group AD and group Con, and the total score of.2.MMSE in group Con and group AD were compared with that of group Con. There were significant differences in total MMSE score, orientation, attention and computational power, delayed recall, writing and visual space, while there was no significant difference in immediate recollection, naming, retelling, reading and understanding. Group.CSVD (see Table 2) compared with group Con, there were statistical differences in MMSE total score, orientation, immediate memory, attention and computational power, delayed recall, rehearsal, understanding, writing and visual space, but there was no statistical difference between naming and reading (see Table 3) the.AD group was compared with the CSVD group in orientation, attention and calculation, and rehearsal existence. There was no difference in MMSE total score, instant memory, delayed memory, naming, reading, reading, writing, and visual spatial awareness (see Table 4).3.MoCA total score and subproject AD, compared with the Con group, in all MoCA subprojects except the nomenclature and the CIS back (see Table 5).CSVD group in all MoCA subgroups compared with the Con group. There were significant differences in the project (see Table 6) the.AD group was compared with the CSVD group, and there was no statistical difference in the total score of MoCA, immediate recall, replicating cube, clock test, back, attention, fluency, abstraction and orientation, but there was no statistical difference in the connection test, naming, CIS back, computational force, rehearsal and delayed memory (Table 7). 1 conclusion 1 Compared with AD, the cognitive dysfunction caused by the diffuse CSVD was more closely related to age, hypertension and diabetes. Compared with AD, the cognitive impairment caused by the diffuse CSVD was more extensive, and the MoCA score was lower, indicating that the sensitivity of MoCA in evaluating the cognitive function of the scattered CSVD was higher than that of MMSE.3, compared with AD. The cognitive impairment caused by type CSVD has no difference in naming, retelling and free recollection; scattered CSVD has more damage in immediate memory, computational force and attention, fluency of words, f abstract thinking and executive function, while the performance of the orienteering is better than that of AD..
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1

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