CAJ | 학술논문

目的分析不同类型的血管性认知功能损害(VCI)患者的执行功能损害特征.方法经头颅MRI证实为皮质下缺血性小血管病(SIVD)患者64例,其中16例单一的执行功能损害(s-VCI-ND)、26例多个认知领域损害(m-VCI-ND)和22例血管性痴呆(VaD)患者,完成一系列神经心理测验,包括总体认知水平、记忆、语言、注意/执行功能、空间结构能力等各个认知领域.其中执行功能检查包括定势转移、优势抑制、工作记忆、概念形成和流畅性5个分因子,共15种独立的分测验.结果汉诺塔测验、示踪排序测验、同步听觉连续加法测验等在非痴呆VCI(VCI-ND)患者中的完成率低于50%,不适合VCI-ND的检测;s-VCI-ND组与健康对照组比较,分别反映4种执行功能成分的连线测验B耗时数(216.5±69.3、137.4±37.9)、Stroop色词测验卡片C耗时数(115.4±30.1、72.9±17.5)、卡片分类测验(1.9±1.4、2.7±1.2)和范畴流畅性测验(列举动物14.2±2.3、17.7±4.4)差异具有统计学意义(t=4.73、5.72、2.04、3.53,均P<0.05);VCI-ND的认知表现介于健康老人组和VaD组之间,其中m-VCI-ND有比较严重的执行功能损害和情景与语义记忆障碍,其认知缺损模式接近VaD,很可能是VaD的前期状态.结论 SIVD所致VCI的执行功能损害缺乏选择性,部分执行功能测验可以作为早期检测VCI-ND的敏感工具.
목적 분석불동류형적혈관성인지공능손해(VCI)환자적집행공능손해특정.방법 경두로MRI증실위피질하결혈성소혈관병(SIVD)환자64례,기중16례단일적집행공능손해(s-VCI-ND)、26례다개인지영역손해(m-VCI-ND)화22례혈관성치태(VaD)환자,완성일계렬신경심리측험,포괄총체인지수평、기억、어언、주의/집행공능、공간결구능력등각개인지영역.기중집행공능검사포괄정세전이、우세억제、공작기억、개념형성화류창성5개분인자,공15충독립적분측험.결과 한낙탑측험、시종배서측험、동보은각련속가법측험등재비치태VCI(VCI-ND)환자중적완성솔저우50%,불괄합VCI-ND적검측;s-VCI-ND조여건강대조조비교,분별반영4충집행공능성분적련선측험B모시수(216.5±69.3、137.4±37.9)、Stroop색사측험잡편C모시수(115.4±30.1、72.9±17.5)、잡편분류측험(1.9±1.4、2.7±1.2)화범주류창성측험(열거동물14.2±2.3、17.7±4.4)차이구유통계학의의(t=4.73、5.72、2.04、3.53,균P<0.05);VCI-ND적인지표현개우건강노인조화VaD조지간,기중m-VCI-ND유비교엄중적집행공능손해화정경여어의기억장애,기인지결손모식접근VaD,흔가능시VaD적전기상태.결론 SIVD소치VCI적집행공능손해결핍선택성,부분집행공능측험가이작위조기검측VCI-ND적민감공구.
Objective To investigate the executive function features of different subtypes of vascular cognitive impairment (VCI). Methods Sixty-four subjects with subcortical ischaemic vascular disease (SIVD) presumed by medical history and neuroimaging (cranial MRI) were recruited. The clinical and neuropsychological features of the 4 groups were compared: cognitive normal control (n=25), simple executive impairment of VCI-ND (s-VCI-ND, n=16), multi-domain impairment of VCI-ND (m-VCI-ND, n=26) and vascular dementia (VaD) patients (n=22). All participants underwent neuropsychological tests covering global cognitive function, executive function, memory function, language function and visual spatial skills. The executive tests included 15 independent subtest reflect set shifting, inhibition of prepotent responses, working memory, concept formation and fluency. Results Tower of Hanoi, self ordered pointing test and paced auditory serial addition test were not suitable for identification of VCI-ND because their finish rates were less 50%. Performance of trail making test (216.5±69.3 vs 137.4±37.9), Stroop color words test (115.4±30.1 vs 72.9±17.5), California cards sorting test-Chinese version (1.9±1.4 vs 2.7±1.2)and animal category fluency test(14.2±2.3 vs 17.7±4.4) had significant difference between s-VCI-ND group and cognitive normal control group (t=4.73, 5.72, 2.04 and 3.53, all P<0.05) and these tests were applicable and sensitive assessment tools in all executive tests. Time-consuming index showed more sensitivity than correct index in executive function. Neuropsychological deficits of m-VCI-ND patients showed lower than that of s-VCI-ND group and better than that of VaD patients. It was likely that the m-VCI-ND was a transition state between normal aging and VaD. Conclusion Executive dysfunction of VCI caused by SIVD is short of specificity. Some tests may appear earlier in screening of VCI-ND.