血管源性轻度认知障碍的AD8、Cog12筛查及~1H-MRS特点研究

发布时间：2018-08-05 20:09

【摘要】：研究目的 1.通过对认知正常者、血管性痴呆（vascular dementia，VD）和血管源性轻度认知障碍（vascular mild cognitive impairment，v-MCI）患者进行一系列神经心理学量表测验，探讨AD8（Alzheimer disease8）、Cog12（cognitive impairment assessment scale12）在v-MCI筛查中的应用价值。 2.通过对v-MCI患者和认知正常患者进行质子磁共振波谱（proton magneticresonance spectroscopy，1H-MRS）检查，探讨经AD8、Cog12筛查的v-MCI患者1H-MRS特点。研究方法第一部分：以2012年2月至2014年2月因脑血管病或脑血管病危险因素在中国人民解放军第八十八医院神经内科门诊就诊或住院的患者为研究对象。研究对象分为三组：正常对照（normal control，NC）组、VD对照组和v-MCI组。对所有研究对象进行AD8、Cog12等一系列神经心理学量表的检测，分析比较不同组间量表评分，研究量表的敏感度和特异度。第二部分：对第一部分中年龄大于50岁的v-MCI患者和NC组患者进行颅脑核磁共振（magnetic resonance imagine，MRI）平扫，剔除有大面积脑梗死、关键部位脑梗死（如额叶、丘脑、海马等）以及弥漫性脑白质病变者，对符合条件者进行1H-MRS检查，取双侧的额叶、颞叶、丘脑和海马为感兴趣区（region of interest，ROI），以N-乙酰天冬氨酸（N-acetylaspartate, NAA）、胆碱复合物（choline, Cho）、肌酸复合物（creatine, Cr）为观察指标，计算上述部位NAA/Cr、Cho/Cr值，分析两组间及组内左右两侧不同部位NAA/Cr、Cho/Cr值的变化，探讨波谱早期检测v-MCI的价值。并将符合条件的v-MCI患者分为AD8评分正常者和AD8评分增高者两组，比较两组间代谢物水平的差异。研究结果第一部分： 1.NC组、VD对照组和v-MCI组患者在年龄、性别、受教育年限方面无明显差异（P0.05）。 2.v-MCI组与NC组、VD对照组相比，高血压和脑血管病史的比率高于NC组，，低于VD对照组（χ2检验，P0.05）；心脏病、糖尿病、高脂血症及吸烟、饮酒史的比率与NC组、VD对照组相比无明显差异（χ2检验，P0.05）。 3.v-MCI组MMSE、Moca评分明显高于VD对照组，而明显低于NC组（P0.01）；AD8、Cog12评分明显高于NC组而明显低于VD对照组，差异有统计学意义（P0.01）。 4.在区别认知正常患者和v-MCI患者方面：（1）MMSE与Moca相比无明显差异（P0.05），AD8与Cog12相比无明显差异（P0.05），而MMSE和Moca与AD8和Cog12相比，AD8和Cog12优于MMSE和Moca，差异显著（P0.05）。（2）当MMSE取26.5为截断值（cut-off）时，其敏感度和特异度略低于Moca取23.5为截断值时的敏感度和特异度，但总体水平相当；当AD8和Cog12均取1.5为临界值时，其敏感度和特异度相当，但均高于MMSE取26.5、Moca取23.5为截断值时的敏感度和特异度。 5.在识别VD患者与v-MCI患者方面，MMSE、Moca、AD8和Cog12均具有较高的准确性，差异无统计学意义（P0.05）。 6.三组患者在各认知域评分方面，v-MCI组评分除Stroop色词测验C部分错误反应得分与计时高于NC组（P0.05），而低于VD对照组外，其余各项评分明显低于NC组（P0.05），高于VD对照组（P0.05）。v-MCI组和VD组延时记忆较瞬时记忆评分有所增加（P0.05）。第二部分： 1.v-MCI组患者双侧额叶、颞叶、海马、丘脑的NAA/Cr值均低于NC组，差异显著（P0.05）。各部位的Cho/Cr值在v-MCI组和NC组之间差异无统计学意义（P0.05）。 2.v-MCI组左侧额叶、颞叶、海马、丘脑的NAA/Cr值均低于对侧比值，差异有统计学意义（P0.05），而双侧的Cho/Cr值无明显差异。（P0.05）。 3.v-MCI患者中AD8评分增高者与AD8评分正常者比较，左侧4个部位NAA/Cr代谢物水平降低，差异有统计学意义（P0.001），右侧4个部位NAA/Cr值无明显差异（P0.05）。研究结论第一部分：在区别v-MCI患者方面，与MMSE、Moca相比，AD8、Cog12具有较好的效度。在识别VD方面，MMSE、Moca、AD8和Cog12均具有较高的效度。AD8、Cog12筛查有助于早期发现v-MCI。第二部分：经AD8、Cog12筛查的v-MCI患者在MRS观察到额叶、颞叶、丘脑、海马代谢异常，以左侧为著。研究意义本研究详细分析了AD8、Cog12量表早期检测v-MCI认知功能的价值和1H-MRS特点，证实了AD8、Cog12量表在识别v-MCI方面的敏感性，从而为v-MCI的早期筛查提供了新方法。
[Abstract]:research objective
1. the application value of AD8 (Alzheimer disease8) and Cog12 (Alzheimer disease8) was explored through a series of neuropsychological tests for patients with cognitive normal vascular dementia (VD) and vascular mild cognitive impairment (v-MCI).
2. by conducting proton magnetic resonance spectroscopy (proton magneticresonance spectroscopy, 1H-MRS) examination of v-MCI patients and cognitive normal patients, the 1H-MRS characteristics of v-MCI patients screened by AD8 and Cog12 were investigated.
research method
Part one:
The subjects were divided into three groups: normal control (normal control, NC) group, VD control group and v-MCI group, and AD8, Cog12, etc. for all the subjects were studied in the Department of Neurology of No.88 Hospital of PLA for the risk factors of cerebrovascular disease or cerebrovascular disease from February 2012 to February 2014. A series of neuropsychological scale tests were conducted to analyze and compare the scores of different interval scales, and to study the sensitivity and specificity of the scale.
The second part:
Craniocerebral magnetic resonance (magnetic resonance imagine, MRI) scan was performed in the first part of the v-MCI patients and NC groups aged more than 50 years old, and the patients with large area cerebral infarction and cerebral infarction (such as frontal, thalamus, hippocampus, etc.) and diffuse white matter lesions were eliminated. The 1H-MRS examination was performed to the eligible subjects, and bilateral frontal and temporal lobes were taken. The thalamus and hippocampus are region of interest (ROI), with N- acetyl aspartic acid (N-acetylaspartate, NAA), choline complex (choline, Cho), and creatine complex (creatine, Cr) as the observation index. The value of v-MCI was detected early in the spectrum, and the eligible v-MCI patients were divided into two groups with normal AD8 score and higher AD8 score, and the difference of metabolites level between the two groups was compared.
Research results
Part one:
1.NC group, VD control group and v-MCI group had no significant difference in age, sex and education years (P0.05).
Compared with group NC and group VD, the ratio of hypertension and cerebrovascular history was higher than that of the group NC, which was lower than that of the VD control group (x 2 test, P0.05); the rate of heart disease, diabetes, hyperlipidemia and smoking, and the rate of drinking history were not significantly different from that of the NC group and VD control group (x 2 test, P0.05).
3.v-MCI group MMSE, Moca score was significantly higher than the VD control group, but significantly lower than the NC group (P0.01), AD8, Cog12 score was significantly higher than the NC group, and significantly lower than the VD control group, the difference was statistically significant (P0.01).
4. in distinguishing between normal cognitive patients and v-MCI patients:
(1) there is no significant difference between MMSE and Moca (P0.05), and there is no significant difference between AD8 and Cog12 (P0.05), while MMSE and Moca are better than AD8 and Cog12.
(2) when MMSE takes 26.5 as a truncated value (cut-off), its sensitivity and specificity are slightly lower than the sensitivity and specificity of Moca taking 23.5 as a truncated value, but the overall level is equal. When both AD8 and Cog12 take 1.5 as the critical value, their sensitivity and specificity are equivalent, but both are higher than MMSE and 26.5, and Moca takes 23.5 as a truncated value.
5. MMSE, Moca, AD8 and Cog12 had higher accuracy in identifying VD patients and V-MCI patients, and there was no significant difference (P 0.05).
6. in the cognitive domain score of the three groups, group v-MCI score was higher than that of group NC (P0.05), except the Stroop color word test C, and the other scores were lower than that of the NC group (P0.05), which was higher than that in the VD control group (P0.05).V-MCI group and the VD group.
The second part:
The NAA/Cr values of frontal lobes, temporal lobes, hippocampus and thalamus in group 1.v-MCI were lower than those in group NC (P0.05). There was no significant difference in the Cho/Cr value of each part between the v-MCI group and the NC group (P0.05).
The NAA/Cr values of the left frontal lobe, the temporal lobe, the hippocampus and the thalamus in the 2.v-MCI group were all lower than the contralateral ratio (P0.05), but there was no significant difference in the bilateral Cho/Cr values (P0.05).
The levels of NAA/Cr metabolites in the 4 parts of the left side of the 3.v-MCI patients were lower than those in the normal AD8 scores. The difference was statistically significant (P0.001), and there was no significant difference in the NAA/Cr value between the 4 parts of the right side (P0.05).
research conclusion
Part one:
Compared with MMSE, Moca, AD8, Cog12 has better validity in distinguishing v-MCI patients. MMSE, Moca, AD8 and Cog12 have higher validity.AD8 in the identification of VD. Cog12 screening helps to identify the early stages.
The second part:
In v-MCI patients screened by AD8 and Cog12, abnormal metabolism in frontal lobe, temporal lobe, thalamus and hippocampus was observed in MRS, with left side as the center.
research meaning
This study analyzed the value and 1H-MRS characteristics of the early detection of v-MCI cognitive function in the AD8 and Cog12 scale, and confirmed the sensitivity of the AD8 and Cog12 scale in identifying v-MCI, thus providing a new method for the early screening of v-MCI.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749.1

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