中年人脑微出血与血管性认知障碍无痴呆的SWAN与MoCA相关性研究

发布时间：2018-04-10 15:06

本文选题：中年人 + 神经心理量表　；参考：《南方医科大学》2014年硕士论文

【摘要】：目的：用MoCA (Montreal Cognitive Assessment)诊断出轻度认知障碍无痴呆的中年病人,结合高场强磁共振扫描仪对发现脑微出血(cerebral microbleeds)者进行研究。通过年龄分组后的相关比较结果,探讨神经心理量表与SWAN联合后对中年血管性轻度认知障碍无痴呆的诊断。材料与方法：通过对经神经心理量表——HAMD (Hamilton Depression Rating Scale for Depression)、MMSE (Mini-Mental State Examination)及MoCA评估后存在轻度认知障碍并无痴呆的神经内科住院病人行全脑SWAN,选出33例存在微出血的样本组,与20例健康对照进行分组研究,其中样本组45-52岁10例,53-59岁23例。两组样本年龄、受教育程度符合正态分布。所有受试对象均无其它神经系统疾病史、外伤史,无糖尿病。使用GE公司的3.0T SIGNA EXITE超导型全身磁共振扫描仪,采用八通道头部相控阵线圈。所有受检对象接受磁共振全脑T1WI、T2WI、T2FLAIR、DWI及SWAN检查。SWAN采用双次激发的3D-SWAN序列,扫描时间为5分钟。在GE公司提供的ADW4.3工作站上,利用Functool软件对SWAN数据资料进行最小密度投影后处理。具体处理步骤如下：SWAN的原始数据是一系列连续层面的图像对,每一对图像包括在解剖结构上一一对应的幅值图和相位图。通过包括复数重组,K空间滤波取出伪影,相位蒙片和加权等步骤后,得到一系列连续的图像层,最后从这些图像层里得到连续的血管结构和微出血的图像(这些病灶或静脉血管在SWAN中多显示为低信号),随后用Min1P在低密度组织的三维重建上对图像后处理,之后在获得的最小密度投影图上对每个研究对象的MBs (Microbleeds)位置及数量进行记录。用峰度(Kurtosis)分析不同组样本的年龄差异；不同年龄组样本间量表得分的关系选择探索性分析(Exploratory Factor Analysis); MBs与量表之间的相关性选Pearson相关分析。以上统计分析通过SPSS16.0统计软件包完成,P值0.05认为差异有统计学意义。结果： 1.1、样本年龄呈正态分布(年龄分布Q-Q图),平均年龄54.26岁。 1.2、样本年龄分布形态提示年龄位于53-59岁数量较多(k=—0.546,峰度分析)。 1.3、常规年龄差异无统计学意义(P=0.206,常规统计学评估)。 2、45-49岁组受教育程度最高(P0.05,两样本T检验)。 3.1、MMSE评价结果显示,样本均无痴呆及抑郁。 3.2、样本病人组量表结果均表现为轻度认知障碍无痴呆,ICC值0.755(重测信度检验)。 3.3、所有不同年龄组间病人量表得分无差异(P=53.4444)；量表的分异常的年龄分界线为56岁(探索性分析)。 3.4、对照组一例样本MoCA评分小于25分,考虑为神经退行性变较重所致, 其余量表结果均属于正常水平。 4.1.1、样本病人组脑微出血仅位于一个脑叶内的有：额叶2例,顶叶2例,枕叶1例,基底节3例,丘脑6例,幕下9例；大于等于两个脑叶内的为10例。 4.1.2、样本出现脑微出血,无论位于幕上、幕下或是全脑,都会导致认知水平下降,产生轻度认知障碍无痴呆(r=0.13, Pearson Correlation)。 4.2、样本病人组T2FLAIR均发现脑白质变性,TlWI、T2WI及DWI无明显其它病灶；对照组中10例发现脑白质变性,其余10例影像学检查结果无异常。结论： 1、神经精神量表HAMD、MMSE及MoCA相结合,能诊断中年人患轻度认知障碍无痴呆,且患病年龄分界为56岁。 2、出现脑微出血,无论位于幕上、幕下或是全脑,都会导致患者认知水平下降,产生轻度认知障碍无痴呆。因此我们认为,神经心理量表MoCA与SWAN结合,能诊断中年病人由脑微出血导致的的血管性认知障碍无痴呆。
[Abstract]:Purpose :

In the middle - aged patients with mild cognitive impairment and no dementia by MoCA ( Montreal Assessment Assessment ) , the authors studied the patients with cerebral microbleeds combined with high field intensity magnetic resonance scanner . The diagnosis of mild cognitive impairment in middle - aged patients with mild cognitive impairment was investigated by means of correlation results after age grouping .

Materials and Methods :

All subjects received magnetic resonance all - brain T _ 1WI , T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ ( T _ T ) and weighted imaging .

The age difference of different group samples was analyzed by Kurtosis .
The correlation between the scores of the samples of different age groups was selected as exploratory factor analysis ; the correlation between the MBs and the scale was Pearson correlation analysis . The above statistical analysis was completed by SPSS 16.0 statistical software package , and the difference was found to be statistically significant .

Results :

1.1 . The age of the samples was normal distribution ( age distribution Q - Q ) . The mean age was 54.26 years .

1.2 . The age distribution of the samples showed that the age was in the range of 53 - 59 years ( k = - 0.546 , peak analysis ) .

1.3 General age difference was not statistically significant ( P = 0.206 , routine statistical evaluation ) .

2 . The education level of 45 - 49 years old group was the highest ( P0.05 , two sample T tests ) .

3.1 . The results of MMSE evaluation showed that none of the samples had dementia and depression .

3.2 The results of the sample patient group showed mild cognitive impairment without dementia , with an ICC value of 0.755 ( retest reliability test ) .

3.3 All patients with different age groups had no difference ( P = 53.4444 ) .
The dividing line of the sub - anomaly of the scale was 56 years old ( exploratory analysis ) .

3.4 . One sample of the control group had a MoCA score of less than 25 points , which was considered to be due to the heavy degeneration of the nerve ,

The remaining scale results were normal .

4.1 . 1 The cerebral microbleeds in the sample patients were located in only one brain lobe : frontal lobe 2 , parietal 2 , occipital lobe 1 , basal ganglia 3 , thalamus 6 , supratentorial 9 ;
more than or equal to 10 cases within the two brain lobes .

4.1 . 2 The brain microbleeds in the sample , whether located on the screen , under the screen or the whole brain , result in a decrease in cognitive level , with mild cognitive impairment no dementia ( r = 0.13 , Pearson Correlation ) .

4.2 . All patients with T2FLAIR showed no obvious other foci of brain white matter degeneration , T _ WI , T _ T _ T _ T and DWI .
In the control group , there were 10 cases of brain white matter degeneration , and the other 10 cases showed no abnormality . Conclusion :

1 . Combined with the neuropsychiatric rating scale , MMSE and MoCA , the middle - aged people were diagnosed with mild cognitive impairment without dementia , and the age of illness was 56 years .

2 . The occurrence of cerebral microbleeds , whether located on the supratentorial , supratentorial or all - brain , leads to a decrease in the cognitive level of the patient , resulting in a mild cognitive impairment of dementia .

Therefore , the neuropsychological scale MoCA combined with SWAN can diagnose vascular cognitive impairment caused by cerebral microbleeds in middle - aged patients without dementia .

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749.1;R743.34;R445.2

【参考文献】