中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2014年
1期
12-16
,共5页
侯正华%袁勇贵%柏峰%侯钢
侯正華%袁勇貴%柏峰%侯鋼
후정화%원용귀%백봉%후강
老年人%抑郁症%恢复期%白质纤维束%认知%随访研究
老年人%抑鬱癥%恢複期%白質纖維束%認知%隨訪研究
노년인%억욱증%회복기%백질섬유속%인지%수방연구
Aged%Depressive disorder%Convalescence%Fiber tracts%Cognition%Follow-up studies
目的 探讨恢复期老年抑郁症(Remitted Geriatric Depression,RGD)患者随访前后白质长纤维束完整性与认知功能改变之间的关联性.方法 采用MMSE、听觉语言学习测试(Auditory Verbal Learning Test,AVLT)、数字符号转换测试(Symbol Digit Modality Test,SDMT)、连线测试(Trail Making Test,TMT)A和B、数字广度测试(Digit Span Test,DST)对14例RGD患者(RGD组)和19名健康志愿者(对照组)在随访前后分别进行一般临床资料和神经心理学评估,采用1.5 Tesla MRI扫描收集弥散张量成像(diffusion tensor imaging,DTI)图像,采用DTI studio软件对DTI数据进行处理,计算兴趣区(region of interesting,ROI)纤维束的各向异性值(fraction anisotropy,FA).结果 (1)基线时,RGD组AVLT、SDMT、TMT A和B、DST与对照组比较差异有统计学意义[RGD组:(5.93±2.56)、(25.00±15.04)、(133.50±96.66)、(237.71±138.42)、(11.79 ±2.08)分;对照组:(8.16±1.83)、(34.95 ±8.89)、(69.58±27.92)、(139.74±38.11)、(13.16 ±1.74)分;P＜0.01或P＜0.05];RGD组随访时MMSE、AVLT、DST[分别为(27.79 ±3.97),(5.00±2.83),(11.71 ±2.13)分]较基线时均有不同程度的下降,SDMT、TMT-A、TMT-B[分别为(27.07±15.78),(70.43 ±25.52),(157.71 ±36.92)分]成绩有所上升,但仅TMT-A和TMT-B成绩随访前后的变化差异有统计学意义(P =0.038,0.032);随访21个月后RGD组DST得分低于对照组[(11.71±2.13),(14.05 ±2.72)分],P＜0.01].(2)基线时,RGD组左侧扣带回后部FA值低于对照组(0.50±0.08比0.57 ±0.05;P=0.015),随访时RGD组右侧额枕束FA值低于对照组(0.50±0.03比0.54 ±0.06;P =0.025);随访时,RGD组胼胝体压部FA值较基线时下降(0.83±0.05比0.77 ±0.06;P =0.013),对照组左侧扣带束中部FA值下降(0.60±0.06比0.54 ±0.06;P =0.011).(3)RGD组胼胝体压部FA值下降程度与SDMT成绩增加值呈显著性相关(Pearson's相关系数r=-0.617,P=0.025).结论 老年抑郁症患者的纤维连接异常和认知损害密切相关,白质长纤维束完整性受损可能损害患者认知功能.
目的 探討恢複期老年抑鬱癥(Remitted Geriatric Depression,RGD)患者隨訪前後白質長纖維束完整性與認知功能改變之間的關聯性.方法 採用MMSE、聽覺語言學習測試(Auditory Verbal Learning Test,AVLT)、數字符號轉換測試(Symbol Digit Modality Test,SDMT)、連線測試(Trail Making Test,TMT)A和B、數字廣度測試(Digit Span Test,DST)對14例RGD患者(RGD組)和19名健康誌願者(對照組)在隨訪前後分彆進行一般臨床資料和神經心理學評估,採用1.5 Tesla MRI掃描收集瀰散張量成像(diffusion tensor imaging,DTI)圖像,採用DTI studio軟件對DTI數據進行處理,計算興趣區(region of interesting,ROI)纖維束的各嚮異性值(fraction anisotropy,FA).結果 (1)基線時,RGD組AVLT、SDMT、TMT A和B、DST與對照組比較差異有統計學意義[RGD組:(5.93±2.56)、(25.00±15.04)、(133.50±96.66)、(237.71±138.42)、(11.79 ±2.08)分;對照組:(8.16±1.83)、(34.95 ±8.89)、(69.58±27.92)、(139.74±38.11)、(13.16 ±1.74)分;P＜0.01或P＜0.05];RGD組隨訪時MMSE、AVLT、DST[分彆為(27.79 ±3.97),(5.00±2.83),(11.71 ±2.13)分]較基線時均有不同程度的下降,SDMT、TMT-A、TMT-B[分彆為(27.07±15.78),(70.43 ±25.52),(157.71 ±36.92)分]成績有所上升,但僅TMT-A和TMT-B成績隨訪前後的變化差異有統計學意義(P =0.038,0.032);隨訪21箇月後RGD組DST得分低于對照組[(11.71±2.13),(14.05 ±2.72)分],P＜0.01].(2)基線時,RGD組左側釦帶迴後部FA值低于對照組(0.50±0.08比0.57 ±0.05;P=0.015),隨訪時RGD組右側額枕束FA值低于對照組(0.50±0.03比0.54 ±0.06;P =0.025);隨訪時,RGD組胼胝體壓部FA值較基線時下降(0.83±0.05比0.77 ±0.06;P =0.013),對照組左側釦帶束中部FA值下降(0.60±0.06比0.54 ±0.06;P =0.011).(3)RGD組胼胝體壓部FA值下降程度與SDMT成績增加值呈顯著性相關(Pearson's相關繫數r=-0.617,P=0.025).結論 老年抑鬱癥患者的纖維連接異常和認知損害密切相關,白質長纖維束完整性受損可能損害患者認知功能.
목적 탐토회복기노년억욱증(Remitted Geriatric Depression,RGD)환자수방전후백질장섬유속완정성여인지공능개변지간적관련성.방법 채용MMSE、은각어언학습측시(Auditory Verbal Learning Test,AVLT)、수자부호전환측시(Symbol Digit Modality Test,SDMT)、련선측시(Trail Making Test,TMT)A화B、수자엄도측시(Digit Span Test,DST)대14례RGD환자(RGD조)화19명건강지원자(대조조)재수방전후분별진행일반림상자료화신경심이학평고,채용1.5 Tesla MRI소묘수집미산장량성상(diffusion tensor imaging,DTI)도상,채용DTI studio연건대DTI수거진행처리,계산흥취구(region of interesting,ROI)섬유속적각향이성치(fraction anisotropy,FA).결과 (1)기선시,RGD조AVLT、SDMT、TMT A화B、DST여대조조비교차이유통계학의의[RGD조:(5.93±2.56)、(25.00±15.04)、(133.50±96.66)、(237.71±138.42)、(11.79 ±2.08)분;대조조:(8.16±1.83)、(34.95 ±8.89)、(69.58±27.92)、(139.74±38.11)、(13.16 ±1.74)분;P＜0.01혹P＜0.05];RGD조수방시MMSE、AVLT、DST[분별위(27.79 ±3.97),(5.00±2.83),(11.71 ±2.13)분]교기선시균유불동정도적하강,SDMT、TMT-A、TMT-B[분별위(27.07±15.78),(70.43 ±25.52),(157.71 ±36.92)분]성적유소상승,단부TMT-A화TMT-B성적수방전후적변화차이유통계학의의(P =0.038,0.032);수방21개월후RGD조DST득분저우대조조[(11.71±2.13),(14.05 ±2.72)분],P＜0.01].(2)기선시,RGD조좌측구대회후부FA치저우대조조(0.50±0.08비0.57 ±0.05;P=0.015),수방시RGD조우측액침속FA치저우대조조(0.50±0.03비0.54 ±0.06;P =0.025);수방시,RGD조변지체압부FA치교기선시하강(0.83±0.05비0.77 ±0.06;P =0.013),대조조좌측구대속중부FA치하강(0.60±0.06비0.54 ±0.06;P =0.011).(3)RGD조변지체압부FA치하강정도여SDMT성적증가치정현저성상관(Pearson's상관계수r=-0.617,P=0.025).결론 노년억욱증환자적섬유련접이상화인지손해밀절상관,백질장섬유속완정성수손가능손해환자인지공능.
Objective This study was aimed to investigate the association between integrity of long association fiber tracts changes and neuropsychological performance in patients with remitted geriatric depression (RGD).Methods Using the Mini Mental State Examination (MMSE),Auditory Verbal Learning Test (AVLT),Symbol Digit Modality Test (SDMT),Trail Making Test-A&B (TMT-A&B),Digit Span Test (DST) to collect general clinical data and neuropsychological data.14 patients with RGD and 19 healthy volunteers as control were recruited in this follow-up study.Subjects were scanned using a General Electric 1.5 Tesla scanner to acquire diffusion tensor imaging (DTI) images.Using the DTI studio software to calculate the fraction anisotropy (FA) value of region of interesting (ROI) in 13 RGD patients and 19 controls.Results (1) At baseline,RGD patients showed significant poorer performance in some specific domain of cognitive function,such as AVLT,SDMT,TMT A&B and DST than controls [RGD patients:5.93±2.56,25.00 ± 15.04,133.50 ±96.66,237.71 ± 138.42,11.79 ±2.08; controls:8.16 ± 1.83,34.95 ± 8.89,69.58 ± 27.92,139.74 ± 38.11,13.16 ± 1.74.At follow-up,the score of MMSE,AVLT,DST in RGD patients showed some degrees of decline (27.79 ±3.97,5.00 ±2.83,11.71 ±2.13,SDMT,TMT-A&B exhibited increased score 27.07 ± 15.78,70.43 ±25.52,157.71 ±36.92,but only the change of TMT-A and B was statistically significant (P =0.038,0.032).After follow-up,the RGD patients exhibited lower scores of DST than controls [(11.71 ±2.13) vs.(14.05 ±2.72),P ＜0.01].(2) At baseline,the FA value of left cingulate fasciculus (posterior) in RGD patients was lower than controls [(0.50 ± 0.08) vs.(0.57 ±0.05),P =0.015].At follow-up,the FA value of right frontooccipital fasciculus in RGD patients was lower compared to controls [(0.50 ± 0.03) vs.(0.54 ± 0.06),P =0.025],the FA value of corpus callosum (splenium) was decreased significantly in RGD patients [(0.83 ± 0.05) vs.(0.77 ± 0.06),P =0.013].In controls,the FA value of left cingulate fasciculus (middle) exhibited significant decrease [(0.60 ± 0.06) vs.(0.54 ± 0.06),P =0.011].(3) Correlation analysis showed that the decreased FA value of splenium of corpus callosum was negatively related to the increase of SDMT score (r =-0.617,P =0.025).Conclusions The findings suggest that the regional fiber connection change be closely related to cognitive impairment.The abnormality of integrity long white matter fiber bundle might be associated with impaired cognitive function in patients with RGD.
