脑白质疏松体积测量法的试用及相关认知障碍的特点

发布时间：2018-06-17 19:40

本文选题：白质疏松 + 血管性认知功能障碍　；参考：《广州医科大学》2014年硕士论文

【摘要】：【研究背景】脑白质疏松(leukoaraiosis，LA)是一类常见于中老年人的白质病变，可能会引起认知功能障碍、步态异常和尿便失禁等症状。LA的病因未完全明确，但越来越多的研究提示LA是一种皮质下小血管病变，LA相关的认知下降被认为是血管性认知功能障碍（vascular cognitive impairment，VCI）的一个亚型。VCI表现形式多样，目前尚缺乏公认的神经心理学检查，这是导致既往LA认知功能方面研究结果不一致的重要原因之一。2006年美国国立神经疾病卒中研究所和加拿大卒中网（National Institute of Neurological Disorders andStroke-Canadian，NINDS-CSN）筛选制定了一套60分钟方案神经心理检查专门用于VCI的研究，国内尚未见应用全套60分钟方案检查于LA的研究。另外，对于LA病变程度的评估，国内均使用视觉定性的评估方法，，未见通过测定LA体积来研究其与认知功能的报道。【目的】采用60分钟方案神经心理检查法，研究LA患者的认知功能特点；尝试定量测算LA体积，分析其与定性评分法和LA认知功能的相关性。【方法】对LA病例组60例（根据Fazekas评分标准分为轻度、中度、重度三组）及健康对照组29例，应用美国国立神经疾病卒中研究所和加拿大卒中网（NINDS-CSN）推荐的60分钟方案神经心理量表进行记忆力、执行功能、注意力、语言功能和视空间五个认知领域的检查，分析白质疏松患者认知功能损害的特点；应用图像软件Image-pro Plus（IPP）测算LA的体积，分析体积定量测定与Fazekas定性评分的相关性。【结果】 1、与对照组比较：1）轻度病例组分别在连线测验B部分（trail making testB,TMTB）得分、Stroop色词测验C部分（Stroop color word test C,SCWTC）错误数得分、符号数字转换测验（symbol digit modalities test,SDMT）得分、连线测验A部分（trail making test B,TMTA）得分、词语流畅性测验（verbal fluencytest,VFT）15秒动物数得分，两者间的差异有统计学意义；2）中度病例组分别在简易精神状态检查量表（Mini-mental state examination,MMSE）得分、听觉词语学习测验（auditory verbal learning test,AVLT）的即刻回忆、短延时回忆、长延时回忆及再认得分、VFT15秒动物数、45秒动物数及1分钟动物数、SDMT得分、TMTA得分、TMTB得分、SCWTC的耗时数和错误数得分，两者间的差异有统计学意义；3）重度病例组分别在MMSE得分、AVLT即刻回忆、短延时回忆、长延时回忆及再认得分、VFT15秒动物数、45秒动物数及1分钟动物数、波士顿命名（Boston naming test,BNT）得分、画钟测验(clock drawing test,CDT)得分、SDMT得分、TMTA得分、TMTB得分、SCWTC的耗时数得分和错误数得分，两者间的差异有统计学意义。 2、病例组之间比较：1）轻度与中度：除AVLT再认得分、TMTB得分和SCWTC错误数得分两者间差异无统计学意义外，其余测验得分的差异均有统计学意义。2）轻度与重度：除SCWTC错误数得分两者间差异无统计学意义外，其余测验得分的差异均有统计学意义。3）中度与重度：两组间只有TMTB得分的差异有统计学意义，其余测验得分的差异均无统计学意义。 3、使用Image-pro Plus测算的体积与Fazekas定性评分显著正相关,spearman相关系数r=0.828，具有统计学意义。 4、LA体积与MMSE、AVLT即刻回忆、AVLT短延迟回忆、AVLT长延迟回忆、AVLT再认、CDT、AFT45秒动物数、AFT1分钟动物数呈负相关，spearman相关系数r=-0.445～-0.258，具有统计学意义；LA体积与TMTB得分和SCWTC耗时得分呈正相关，spearman相关系数r分别为0.523、0.564，具有统计学意义。【结论】 1、轻度LA患者存在执行功能和注意力损伤，中度和重度LA患者存在语言功能、记忆力、执行功能和注意力损伤，LA患者视空间功能相对保留完整。LA中度病变期，注意力和执行功能障碍显著进展，并出现记忆力和语言功能的损伤；LA重度病变期，执行功能障碍显著进展，记忆力、语言功能和注意力的下降相对平稳。 2、可使用Image-pro Plus软件测算LA的体积。LA患者的总体认知功能、记忆力和执行功能随LA体积增长而下降。
[Abstract]:[background] leukoaraiosis (LA) is a kind of white matter common in middle-aged and elderly people, which may cause cognitive dysfunction, gait abnormalities and urinary incontinence and other symptoms of.LA are not completely clear, but more and more studies suggest that LA is a subcortical small vascular disease, and the cognitive decline associated with LA is considered to be blood. A subtype of vascular cognitive impairment (VCI) has a variety of.VCI manifestations, and there is still a lack of recognized neuropsychological examination. This is one of the important reasons for the inconsistent results of previous LA cognitive functions, one of the national national neurodiseases stroke Institute and the Canadian Stroke Network (Nationa),.2006. L Institute of Neurological Disorders andStroke-Canadian, NINDS-CSN) screening and formulating a set of 60 minute program neuropsychological examination specially used for the study of VCI. There has not been a complete set of 60 minutes for the study of LA. In addition, the assessment of the degree of LA lesions, the use of visual qualitative assessment methods, has not been passed. LA volume was measured to study its cognitive function.
[Objective] to study the cognitive function of LA patients by 60 minute scheme neuropsychological examination, and to try to measure the volume of LA quantificationally and analyze the correlation between the qualitative score and the cognitive function of LA.
[Methods] 60 cases of LA case group (divided into mild, moderate, severe, three groups according to the Fazekas score) and the healthy control group were 29 cases. The memorizing force, executive function, attention, language function and visual space were performed by the national neurologic stroke research institute and the Canadian Stroke Network (NINDS-CSN) recommended by the Canadian Stroke Network (NINDS-CSN). A cognitive field was examined to analyze the characteristics of cognitive impairment in patients with leukoaraiosis. The volume of LA was measured by Image-pro Plus (IPP), and the correlation between volume quantitative determination and Fazekas qualitative score was analyzed.
[results]
1, compared with the control group: 1) the mild case group was scored in the B part (trail making testB, TMTB), the C part of the Stroop color word test (Stroop color word test C), the score of the symbol digital conversion test, the score of the connection test, and the words and expressions. The scores of verbal fluencytest (VFT) 15 seconds were statistically significant; 2) the moderate case group was scored in the simple mental state Checklist (Mini-mental state examination, MMSE), the immediate recollection of the auditory word learning test (auditory verbal learning test, AVLT), the short delay memory, the long delay. Memory and recognition scores, VFT15 seconds animals, 45 seconds of animals and 1 minutes of animals, SDMT scores, TMTA scores, TMTB scores, SCWTC time and error scores, the difference between the two is statistically significant; 3) severe case group in MMSE score, AVLT immediate memory, short delay memory, long delay recall and recognition score, VFT15 second animals The number, the 45 second animal number and the 1 minute animal number, the Boston naming test (BNT) score, the clock test (clock drawing test, CDT) score, the SDMT score, the TMTA score, the TMTB score, the time score and the error number of the SCWTC, the difference between the two has the significance of unified planning.
2, compared with the case group: 1) mild and moderate: except AVLT recognition score, TMTB score and SCWTC error score had no statistical significance, the difference of the other scores were statistically significant.2) mild and severe: except for the difference between the SCWTC error scores, there were differences in the scores of the other tests. Statistical significance.3) moderate and severe: there was statistical difference in the TMTB scores between the two groups, but there was no statistically significant difference in the other test scores.
3, the volume calculated by Image-pro Plus was positively correlated with the qualitative score of Fazekas, and the Spearman correlation coefficient r=0.828 was statistically significant.
4, LA volume and MMSE, AVLT immediate recollection, AVLT short delay memory, AVLT long delayed recall, AVLT recognition, CDT, AFT45 second animal number, AFT1 minute animal number is negative correlation, Spearman correlation coefficient r=-0.445 ~ -0.258, has statistical significance. It has statistical significance.
[Conclusion]
1, patients with mild LA had executive function and attention impairment. Moderate to severe LA patients had language function, memory, executive function, and attention impairment. The visual space function of LA patients retained complete.LA moderate pathological changes, attention and executive dysfunction were significantly progressed, and memory and language function was damaged; LA severe lesions were found. During the period, executive dysfunction progressed significantly, and memory, language function and attentional decline were relatively stable.
2, we can use Image-pro Plus software to measure the volume of LA, the overall cognitive function of.LA patients, and the memory and executive function decrease with the increase of LA volume.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

【参考文献】