脑白质病变与认知功能的相关性研究

发布时间：2018-04-14 14:28

本文选题：脑白质病变 + 认知　；参考：《山东大学》2014年硕士论文

【摘要】：研究目的：研究不同程度、不同部位的脑白质病变(white matter lesions,WML)对患者认知功能的影响,并探究伴有腔隙性脑梗死的白质病变患者的认知功能的特点,对预测脑卒中、痴呆、日常生活能力的下降有重要价值。研究方法：选取于2013年11月至2014年1月在省立医院神经内科门诊及住院就诊的脑白质病变患者96例和正常对照组20例。采集临床资料,并根据颅脑MRI的T2加权像、Flair像,根据病变的严重程度,将WML组分为单纯WML组70例(采用Fazekas等级视觉评分方法又分为,轻度亚组30例,中度亚组20例,重度亚组20例)和WML伴有腔隙性脑梗死(silent lacunar infarcts,LI)组26例。根据白质病变累及的部位,将单纯WML组分为室周旁白质病(periventricular lesions, PVL)亚组39例和皮层下深部白质病变(deep white matter lesions, DWML)亚组31例。应用简明精神状态检查表(MMSE)、蒙特利尔认知功能评估量表(MoCA)、日常生活能力量表(ADL)对所有入选对象进行认知评估。研究结果： (1)WML中、重度亚组简易精神状态检查表(MMSE)及蒙特利尔认知评估量表(MoCA)评分显著低于WML轻度亚组和对照组(P0.05)；WML轻度亚组与对照组仅在MoCA总分、视空间与执行功能得分有统计学差异；WML重度亚组在视空间与执行功能、语言功能、抽象能力、延迟回忆、注意力与计算力得分较WML中度亚组得分较低(P0.05)。 (2)皮层下深部白质病变组MoCA总分、视空间与执行功能比室周旁白质病变组得分较低,而MMSE总分、语言能力、定向力、注意力与计算力、抽象能力、延迟回忆得分差异无统计学意义。 (3)与单纯WML组相比,WML-LI组MMSE、MoCA,总分、视空间与执行功能、语言功能、抽象能力、延迟回忆、定向能力、注意力与计算力得分均有显著降低(P0.05)。研究结论： (1)白质病变到一定程度才会引起认知功能减退；随着白质病变程度越重,患者认知下降越显著。 (2)室周旁白质病变和深部白质病变对认知的影响可能不同。皮层下深部脑白质病变对认知功能的影响较室周旁脑白质病变明显,尤其在视空间与执行功能。 (3)合并腔隙性脑梗死(WML-LI)组患者相较对照组和WML组,认知功能更容易受损。
[Abstract]:Objectives of the study:To study the effects of white matter lesions (WMLs) on cognitive function in patients with white matter lesions, and to explore the characteristics of cognitive function in patients with lacunar infarction.The decline in daily life is of great value.Research methods:From November 2013 to January 2014, 96 patients with leukoencephalopathy and 20 normal controls were selected from Department of Neurology, Department of Neurology, Provincial Hospital.The clinical data were collected. According to the T2-weighted flair images of craniocerebral MRI, the WML group was divided into simple WML group (70 cases) according to the severity of the lesion (30 cases of mild subgroup, 20 cases of moderate subgroup, 30 cases of mild subgroup and 20 cases of moderate subgroup).In severe subgroup (n = 20) and in WML group (n = 26), silent lacunar silent lacunar with lacunar infarction (n = 26).According to the location of white matter lesion, the WML group was divided into three groups: periventricular leukopathy (PVL) group (n = 39) and deep subcortical white matter lesion (WML) subgroup (n = 31).All the subjects were evaluated with MMSE, MMSE, MoCAA and ADL.Results of the study:The scores of MMSE and MMA in severe subgroup were significantly lower than those in WML mild subgroup and control group (P 0.05) and only in the total score of MoCA.The scores of visual space and executive function were statistically different. The scores of visual space and executive function, language function, abstract ability, delayed recall, attention and computational ability were lower than those of WML moderate subgroup (P 0.05).(2) the total score of MoCA, visual space and executive function in deep subcortical white matter lesion group was lower than that in periventricular white matter lesion group, while the total score of MMSE, language ability, orientation, attention and computational ability, abstract ability, and so on.There was no significant difference in delayed recall scores.Compared with WML group, the total score, visual space and executive function, language function, abstract ability, delayed recall, directional ability, attention and computational ability in WML-LI group decreased significantly (P 0.05).The study concluded that:1) leukoencephalopathy caused cognitive impairment to a certain extent, and with the severity of leukoencephalopathy, the cognitive decline was more significant.2) the effects of periventricular white matter lesion and deep white matter lesion on cognition may be different.The effect of deep subcortical white matter lesion on cognitive function was more obvious than that on paraventricular white matter lesion, especially in visual space and executive function.3) the cognitive function of patients with lacunar infarction (WML-LI) group was more easily impaired than that of control group and WML group.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742

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