不同病因轻度认知功能障碍患者早期特征鉴别

发布时间：2018-06-09 06:12

  本文选题：轻度认知功能障碍 + Alzheimer　； 参考：《临床神经病学杂志》2017年04期

【摘要】：目的探讨皮质下小血管病源性轻度认知障碍(MCI-SVD)和Alzheimer's病源性轻度认知障碍(MCI-AD)患者的血管危险因素、脑动脉粥样硬化和脑解剖结构的特征。方法收集48例MCI-SVD患者、40例MCI-AD患者和59名老年对照者的临床资料。采用临床痴呆评定量表(CDR)和蒙特利尔认知评估(MoCA)中文版对患者进行认知功能评估。于入院后采用彩色多普勒超声对患者进行检查,记录左侧及右侧颈内动脉内膜厚度、斑块积分(Crouse积分)以及颈内动脉末段、大脑中动脉、大脑前动脉、大脑后动脉、椎动脉、基底动脉(BA)的平均血管搏动指数(MPI)。同时采用线性测量方法采集患者头颅MRI的脑解剖结构数据。结果与对照组比较,MCI-AD组、MCI-SVD组高血压、糖尿病、吸烟的比率显著升高,Mo CA评分显著降低;MCIAD组低密度脂蛋白胆固醇、载脂蛋白B水平显著降低(P0.05~0.01)。MCI-AD组和MCI-SVD组各血管危险因素差异均无统计学意义(均P0.05)。与对照组比较,MCI-AD组患者视空间和执行功能、注意、计算、抽象、延迟回忆、画钟评分均显著降低(P0.05~0.01);MCI-SVD组视空间和执行功能,注意、计算、抽象、延迟回忆、画钟、定向均显著降低(均P0.01)。MCI-AD组视力空间和执行功能评分显著高于MCI-SVD组(P0.05)。与对照组比较,MCI-SVD组Crouse积分和BA MPI显著增高(均P0.05)。与对照组比较,MCIAD组患者最宽脑沟值、海马沟回比及MCI-SVD组第三脑室和尾状核指数显著升高(均P0.01)。MCI-AD组最宽脑沟值显著高于MCI-SVD组(P0.05)。结论 MCI-AD和MCI-SVD均表现为多领域认知功能的减退。MCI-AD患者皮质和海马显著萎缩,反映了记忆相关的海马-内侧颞叶功能通路破坏;MCI-SVD患者皮质下萎缩,可能由于额叶-皮质下环路的破坏导致认知障碍。两者比较,MCI-SVD患者执行功能损害更显著,而MCI-AD患者皮质萎缩更显著。
[Abstract]:Objective to investigate the vascular risk factors, cerebral atherosclerosis and brain anatomical structure in patients with subcortical microvascular pathogenetic mild cognitive impairment (MCI-SVD) and Alzheimer's with mild cognitive impairment (Alzheimer's). Methods the clinical data of 48 patients with MCI-SVD, 40 patients with MCI-AD and 59 elderly controls were collected. The Chinese version of Clinical dementia rating scale (CDR) and Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function of the patients. The left and right internal carotid artery intima thickness, plaque score and Crouse score were recorded by color Doppler ultrasound after admission. The final segment of the internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the posterior cerebral artery, the vertebral artery, the posterior cerebral artery, and the vertebral artery were recorded. The mean pulsatile index (MPI) of the basilar artery (BAB). At the same time, the brain anatomical structure data of head MRI were collected by linear measurement method. Results compared with the control group, the ratio of hypertension, diabetes, smoking in MCI-SVD group was significantly higher than that in the control group. The level of apolipoprotein B decreased significantly (P 0.05). There was no significant difference in vascular risk factors between MCI-AD group and MCI-SVD group (all P 0.05). Compared with the control group, the visual space and executive function, attention, calculation, abstraction, delayed recall, and clock drawing scores in MCI-AD group significantly decreased the visual space and executive function, attention, calculation, abstraction, delayed recall, clock drawing in MCI-SVD group. The visual acuity and executive function scores of MCI-AD group were significantly higher than that of MCI-SVD group. Compared with the control group, the Crouse score and BA MPI in MCI-SVD group were significantly higher than those in the control group (P 0.05). Compared with the control group, the widest cerebral sulcus, the hippocampal sulcus ratio and the index of the third ventricle and caudate nucleus in MCI-SVD group were significantly higher than those in MCI-SVD group (P 0.01). MCI-AD group was significantly higher than that in MCI-SVD group (P 0.05). Conclusion both MCI-AD and MCI-SVD showed significant atrophy of cortex and hippocampus in patients with multi-domain cognitive impairment. The results indicated that the memory related functional pathway of hippocampal medial temporal lobe destroyed subcortical atrophy in patients with MCI-SVD. Cognitive impairment may result from the destruction of the frontal-subcortical loop. The impairment of executive function was more significant in patients with MCI-SVD than that in patients with MCI-SVD, and cortical atrophy was more significant in patients with MCI-AD.
【作者单位】： 苏州大学附属第一医院老年病科;苏州大学附属第一医院神经内科;
【分类号】：R749.1
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本文编号：1999317