脑白质疏松症患者步态障碍与认知损害的关系

发布时间：2019-07-04 11:12

【摘要】：1.背景与目的随着经济的发展和人们生活水平的提高,我国逐渐进入了老龄化社会。脑白质疏松症(LA),作为皮质下缺血性血管病(SIVD)的一个重要类型,对中老年人身心健康的危害和生活质量影响日益引起医学界重视。LA起病隐匿,由于往往合并诸多脑血管病危险因素,容易被其他相关病情所掩盖,不容易引起患者及家属的警觉。已有大量研究证明LA患者存在步态障碍和认知损害,且有文献报道步态障碍是很多神经系统疾病早期表现,常常预示疾病的发生和发展。即使在健康的中老年人,步态障碍也常高度预示认知功能下降或痴呆的发生。我们拟通过对LA患者认知的临床评估及对步态时空参数的测量,旨在揭示LA患者认知损害和步态障碍的特点,分析认知损害与步态障碍的关系,并探讨其临床意义。2.材料与方法选取42例头颅磁共振(MRI)显示有不同程度LA病变的患者作为试验组(LA组),另选取无LA病变的同期健康体检者13例作为对照组(NC组),根据Wahlund分级方法,将LA组受试者分为轻度(LA1)、中度(LA2)、和重度(LA3)三个亚组。对所有受试者进行临床神经心理学评估和步态测定。神经心理学评估采用简易精神状态检查量表(MMSE)和剑桥老年认知检查表-中国修订版(CA-MCOG-C)。步态评估包括计时“起立-行走”测试(TUG)和P-WALK平板压力系统测试(意大利BTS公司生产),测量步长、步幅、步宽、步频、步速、单支撑相、双支撑相、步行周期等步态时空参数。比较LA组和NC组、LA各亚组与N-C组间认知功能和步态时空参数,选取显著性差异指标进行相关及多元回归分析。3.结果LA组与NC组,LA各亚组与NC组之间年龄、性别组成及教育程度上,差异无统计学意义(P0.05),LA组与对照组,LA各亚组与NC组之间一般资料具有可比性。LA组患者MMSE及CAMCOG-C评分均显著低于NC组,差异有统计学意义(P0.05)。LA组患者较NC组TUG时间延长,步长、步幅缩短,步速减慢,差异均有统计学意义(P0.05)。LA各亚组与NC组比较:随LA严重程度增加,患者MMSE及CAMCOG-C评分降低,4组间差异有统计学意义(P0.05);各步态参数中,随LA严重程度增加,患者TUG时间延长,步长、步幅缩短,步速降低。而步宽增加与步频增快以LA3组较为显著,4组间差异有统计学意义(P0.05)。对LA患者进行相关性分析发现,TUG与MMSE、CAMCOGC评分呈负相关(r=-0.399,P0.01;r=-0.404,P0.01),并与CAMCOG-C子项中记忆和执行呈负相关(r=-0.321,P0.05;r=-0.433,P0.01)。步速与MMSE、CAMCOG-C评分呈正相关(r=0.409,P0.01;r=0.308,P0.05),并与CAMCOG-C中执行功能呈正相关(r=0.535,P0.01)。校正LA等级分级后多元回归分析显示,步态参数与执行功能无相关性。4.结论LA患者步态时空参数存在异常,以步速减慢最为显著,步速减慢可作为LA发生的独立的预测因子。LA患者步态障碍与LA严重程度及认知损害有关,尤其与LA患者的执行功能下降有关。在临床诊治过程中,应关注中老年患者,尤其是具有脑血管病危险因素的患者的步态变化,及时应用智能康复及药物治疗手段,减缓疾病进展,提高患者生活质量。
文内图片：

图片说明LA分级：2级（FLAIR像）
[Abstract]:1. With the development of economy and the improvement of people's living standard, our country has gradually entered an aging society. Leukoaraiosis (LA), as an important type of the subcortical ischemic stroke (SIVD), has increasingly attracted the attention of the medical community to the harm of the physical and mental health of the middle-aged and the elderly and the quality of life. As a result of the risk factors of cerebrovascular disease, it is easy to be covered by other related conditions, and it is not easy to be alert to the patients and their families. A large number of studies have shown that there are gait and cognitive impairment in LA patients, and there is a literature that gait disturbance is an early expression of many nervous system diseases, which often indicates the occurrence and development of the disease. Even in the health of the middle-aged and the elderly, the gait disorder is often highly indicative of a decrease in cognitive function or the occurrence of dementia. Based on the clinical evaluation of LA and the measurement of the time-space parameters of gait, we aim to reveal the characteristics of cognitive impairment and gait disturbance in LA patients, and to analyze the relationship between cognitive impairment and gait disturbance and to explore its clinical significance. Materials and Methods 42 cases of head magnetic resonance (MRI) were selected as the test group (LA group), and 13 patients with a non-LA lesion were selected as the control group (NC group), and the LA group was divided into mild (LA1) group according to the Wahlund classification method. Moderate (LA2), and severe (LA3) subgroups. All subjects were subjected to clinical neuropsychological assessment and gait determination. The neuropsychological assessment used the Simple Mental State Examination Scale (MMSE) and the Cambridge old cognitive checklist-China revision (CA-MCOG-C). Gait assessment includes timing "Stand up.-Walk." test (TUG) and P-WALK plate pressure system test (Italian BTS company production), measurement step size, stride, step width, step frequency, pace, single support phase, dual support phase, walking cycle, and other gait space-time parameters. The cognitive function and the time-space parameter of the gait were compared between the LA group and the NC group, the LA subgroups and the N-C groups, and the significance difference index was selected for correlation and multiple regression analysis. Results There was no significant difference between the group of LA and the NC group, the age, sex and the degree of education between the subgroups of the LA and the NC group (P0.05). The general data between the LA and the control group and the group of LA and the NC group were comparable. The scores of MMSE and CAMCOG-C in the LA group were significantly lower than those in the NC group (P0.05). The scores of MMSE and CAMCOG-C in the patients were lower, and there was a significant difference between the four groups (P0.05); in each of the gait parameters, with the increase of the severity of the LA, the time of the patient's TUG was prolonged, the step size, the stride length and the pace of the patient were decreased. The increase of the step width and the step frequency were significantly higher in the LA3 group and the difference between the four groups was statistically significant (P0.05). There was a negative correlation between TUG and MMSE and CAMCOGC (r =-0.399, P0.01; r =-0.404, P0.01), and negatively correlated with the memory and performance in the children of CAMCOG-C (r =-0.321, P0.05; r =-0.433, P0.01). The pace was positively correlated with MMSE and CAMCOG-C (r = 0.409, P0.01; r = 0.308, P0.05), and was positively correlated with the function in CAMCOG-C (r = 0.535, P0.01). The regression analysis showed that the gait parameters were not related to the performance function after the grading of LA grade. Conclusion The time-space parameter of the gait of LA patients is abnormal, and the step speed is the most significant, and the pace of the pace is slow to be an independent predictor of LA occurrence. The gait disturbance in LA was related to the severity of LA and the cognitive impairment, especially with the decrease in the performance of LA patients. In the course of clinical diagnosis and treatment, attention should be paid to the gait change of the middle-aged and old-aged patients, especially those with risk factors of cerebrovascular disease, to timely apply the intelligent rehabilitation and the treatment of drugs, to slow the disease progression and to improve the quality of life of the patients. Text in the text: Picture illustrates LA rating: Level 2 (FLAIR image)
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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