老年男性脑白质病变患者认知功能特点及危险因素的研究

发布时间：2019-02-27 17:53

【摘要】：背景随着全球老龄化进程的加快，老年人群中认知功能障碍的发生率逐渐增加，人们对“痴呆”投向越来越多的关注。但伴随着研究的深入，学者们认识到痴呆的概念存在着明显的滞后性，轻度认知功能障碍(mild cognitive impairment,MCI)的概念随之运用而生。MCI是痴呆的高危人群，发展成痴呆的危险性是正常老人的10倍，部分患者是痴呆的前期阶段。因此及早发现及干预MCI，以延缓甚至阻止痴呆的发生，具有重要的临床意义。国内外已有大量的研究表明脑白质病变(white matter lesions, WML)与认知功能障碍关系密切，甚至认为WML本身就是认知功能障碍的一个独立危险因素。本研究着眼于不同程度及不同部位WML对老年男性患者认知功能的影响，探讨该人群发生认知功能障碍的危险因素，为以后临床预防工作提供理论依据。全文共包括三部分内容：第一部分老年男性脑白质病变与认知情况筛查目的筛查部队老年男性高干WML与认知情况方法选择2010年3月-2011年3月在我院南楼神经内科住院的老年男性患者179例，采集临床资料，引入神经心理评估量表筛查患者认知情况。结果WML患者114例，占总人数的63.68%，其中MCI44例，AD4例，MD20例。结论部队老年男性患者脑白质病变患病率较高，尤其是80岁以上人群。第二部分老年男性脑白质病变患者认知功能特点的研究目的探讨不同部位不同程度WML对老年男性患者认知功能的影响方法选取住院期间WML患者64例，视觉分析WML的不同程度，并按脑室周围病变（PVL）分类：对照组（PVL=0）16例；轻度组（PVL=1）33例；中重度组（PVL=2或3）15例；按深部脑白质病变（DWML）分类：对照组（DWML=0）12例；轻度组（DWML=1）39例；中重度组（DWML=2或3）13例。分析不同部位不同程度WML对认知功能的影响。结果不同部位及不同程度WML可造成MoCA总分及各分项评分随病情加重降低趋势，其中①PVL：中重度组MoCA总分与对照组、轻度组相比；轻、中重度组定向力得分与对照组相比；中重度组延迟回忆得分与对照组相比；轻度组注意力得分与中重度组相比差别具有统计学意义（P0.05）。②DWML：中重度组MoCA总分与命名得分与对照组相比差别具有统计学意义（P0.05）。结论老年男性患者脑白质病变与认知功能减退有关，脑室旁脑白质病变对认知功能的影响较深部脑白质病变明显。第三部分老年男性脑白质病变患者认知功能障碍危险因素的分析目的探讨老年男性WML患者认知功能障碍的危险因素。方法1.选取住院期间的WML患者64例，引入MoCA量表进行认知心理学评估，收集临床资料，完善实验室及颅脑MRI等检查。2.将患者分成轻度认知功能障碍组（MCI组，31例）和认知功能正常组（NC组，33例），，行单因素分析和多因素Logistic回归分析。结果1.单因素分析两组在年龄、教育年限、吸烟等3方面差别具有统计学意义（P0.05）；2.以有无认知功能障碍为因变量行逐步Logistic回归分析，得到教育年限（P值0.003，OR值0.867）、吸烟（P值0.005，OR值5.151）、腔隙性脑梗死（P值0.037，OR值3.766）与脑白质认知功能障碍的发生有关。结论部队老年男性高干脑白质病变患者认知功能障碍主要与教育年限、腔隙性脑梗死和吸烟有关。
[Abstract]:With the acceleration of the global aging process, the incidence of cognitive dysfunction in the elderly population has increased, and more and more attention has been paid to the "dementia". But with the in-depth of the study, the scholars realized that the concept of dementia was significant, and the concept of mild cognitive impairment (MCI) was used. MCI is a high-risk group of dementia, and the risk of developing dementia is 10 times that of the normal old man, and some of the patients are the early stage of dementia. Therefore, it is of great significance to find and intervene with MCI in order to delay or prevent the occurrence of dementia. At home and abroad, a large number of studies have shown that white matter disease (WML) is closely related to cognitive dysfunction, and even that WML itself is an independent risk factor for cognitive dysfunction. This study focuses on the effect of WML on the cognitive function of the elderly male patients with different degrees and different parts, and discusses the risk factors of cognitive impairment in the population and provides a theoretical basis for future clinical prevention. The full text includes three parts Appearance: The first part of the senile male white matter lesions and the cognition Screening for screening of the situation for the purpose of screening the high-dry WM of the elderly male in the The method of L and cognition was selected from March 2010 to March 2011 in the elderly male in the Department of Neurology of the South Building of our hospital. 179 patients with sex, the clinical data was collected, and the neuropsychological evaluation scale screen was introduced. Results:114 of the patients with WML accounted for 63.68% of the total, of which,44 of them, A Conclusion The prevalence of white matter lesions in the elderly male is high. in particular of that age of 80. the second part of the elderly male is brain-white The purpose of the study of cognitive function in patients with quality disease is to study the different degrees of W in different parts. The Influence of ML on the Cognitive Function of the Elderly Male Patients and the WML in the Hospitalization Period In 64 patients, the different degrees of WML were visually analyzed and classified according to the periventricular lesion (PVL): control group (PVL = 0)16 cases, mild group (PVL = 1)33 cases, moderate to severe group (PVL = 2 or 3)15 cases, classification of deep white matter lesions (DWML): control group (DWML = 0)12 cases, mild group (DWML = 1),39 cases; 13 cases of moderate to severe group (DWML = 2 or 3). The analysis was different The effects of different parts of WML on the cognitive function were studied. Results The total score of MoCA and the score of each sub-item were decreased with the severity of the disease. The total score of MoCA in the moderate and severe group and the control group and the mild group of the MoCA in the moderate and severe group were compared with those in the control group. Compared with the control group, the directional force score of the moderate to severe group is less than that of the control group; the moderate to severe group delayed recall score is compared with the control group; the mild group attention score and the moderate to severe group The difference was statistically significant (P0.05). DWML: The total score of MoCA in moderate and severe group and the named score and control Conclusion The white matter lesions in the elderly are related to the decrease of cognitive function, and the brain of the ventricle is white. The effect of quality lesion on cognitive function is more obvious than that of deep white matter. The third part Analysis of the risk factors of cognitive impairment in senile male white matter lesions to spy on A study on the risk factors of cognitive dysfunction in elderly male WML patients. Methods 1.64 patients with WML in the hospital were selected and the MoCA scale was introduced to study the cognitive function. 2. The patients were divided into mild cognitive impairment group (MCI group,31 cases) and cognitive function normal group (NC group, 33 cases) Results 1. Single factor analysis of two groups at age, 2. The age of education (P-value 0.003, OR value 0.867), smoking (P-value 0.005, OR value 5.151) and lacunar cerebral infarction (P-value 0 .037, OR value 3.766) was related to the occurrence of white matter cognitive dysfunction.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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