CAJ | 학술논문

目的探讨皮质下缺血性血管病(SIVD)认知损害与其他皮质下损害临床特点之间的关系. 方法选择110例SIVD为研究对象,其中认知正常患者34例(SIVD-NCI)、伴有轻度认知损害患者47例(SIVD-MCI)、痴呆患者29例(SIVD-VaD).采用简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、剑桥老年认知量表中文版(CAMCOG-C)、老年抑郁量表(CDT)、日常生活能力量表(ADL)、计时“起立-行走”测试等对患者认知功能、抑郁、日常生活能力以及皮质下损害临床特点进行评定. 结果 3组患者MoCA、CAMCOG-C、MMSE、CDT及ADL评分差异均有统计学意义(F=50.32、55.03,H=85.36、27.39、40.87,均P＜0.05).步态障碍、排尿障碍、假性延髓麻痹、抑郁、跌倒在3组患者间差异有统计学意义(x2=21.69、21.41、25.51、6.91、21.87,均P＜0.05),其中步态障碍随着认知损害程度加重而进一步加重.SIVD-MCI组患者排尿障碍、假性延髓麻痹及跌倒等较SIVD-NCI组患病率显著增加(x2=15.57、16.31、8.92,均P＜0.017)；抑郁在SIVD-NCI及SIVD-VaD组患者之间的差异有统计学意义(x2 =6.90,P＜0.017).皮质下损害临床特点中的情感失禁在3组患者间的差异无统计学意义. 结论 SIVD患者随着认知功能的下降伴随着不同的皮质下损害临床特点,步态障碍随着认知下降而逐渐加重；排尿障碍、假性延髓麻痹及跌倒等特征可侧面反映认知功能从正常发展至轻度损害；抑郁症状可作为SIVD认知损害达到痴呆的标志之一.
목적 탐토피질하결혈성혈관병(SIVD)인지손해여기타피질하손해림상특점지간적관계. 방법 선택110례SIVD위연구대상,기중인지정상환자34례(SIVD-NCI)、반유경도인지손해환자47례(SIVD-MCI)、치태환자29례(SIVD-VaD).채용간역지능정신상태검사량표(MMSE)、몽특리이인지평고량표(MoCA)、검교노년인지량표중문판(CAMCOG-C)、노년억욱량표(CDT)、일상생활능역량표(ADL)、계시“기립-행주”측시등대환자인지공능、억욱、일상생활능력이급피질하손해림상특점진행평정. 결과 3조환자MoCA、CAMCOG-C、MMSE、CDT급ADL평분차이균유통계학의의(F=50.32、55.03,H=85.36、27.39、40.87,균P＜0.05).보태장애、배뇨장애、가성연수마비、억욱、질도재3조환자간차이유통계학의의(x2=21.69、21.41、25.51、6.91、21.87,균P＜0.05),기중보태장애수착인지손해정도가중이진일보가중.SIVD-MCI조환자배뇨장애、가성연수마비급질도등교SIVD-NCI조환병솔현저증가(x2=15.57、16.31、8.92,균P＜0.017)；억욱재SIVD-NCI급SIVD-VaD조환자지간적차이유통계학의의(x2 =6.90,P＜0.017).피질하손해림상특점중적정감실금재3조환자간적차이무통계학의의. 결론 SIVD환자수착인지공능적하강반수착불동적피질하손해림상특점,보태장애수착인지하강이축점가중；배뇨장애、가성연수마비급질도등특정가측면반영인지공능종정상발전지경도손해；억욱증상가작위SIVD인지손해체도치태적표지지일.
Objective To investigate the relationship between cognitive impairment and the other clinical features of subcortical damage in patients with magnetic resonance imaging(MRI)-defined subcortical ischemic vascular disease(SIVD).Methods The cohort for this study included 110 SIVD patients who were divided into 3 groups according to cognitive status:patients with noncognition impairment(SIVD-NCI group,n=34),patients with mild cognitive impairment(SIVD-MCI group,n =47) and patients with vascular dementia (SIVD-VaD group,n =29).The cognitive functions were evaluated by the mini-mental state examination (MMSE) and Montreal cognitive assessment(MoCA),the Cambridge cognitive examination-Chinese version(CAMCOG-C),activity of daily living scale(ADL) and clock drawing task(CDT),etc.Depression symptoms were assessed by the geriatric depression scale (GDS),while the other clinical features of subcortical damage were assessed by the timed " Get-Up and Go" test,etc.Results There were statistically significant differences in the MMSE,MoCA,CAMCOG-C,CDT and ADL scores among the three groups(H=85.36,F=50.32,55.03,H=27.39,40.87,respectively,all P＜0.05).Gait disturbance,urinary disorder,pseudobulbar palsy,depression and falls were statistically significantly different among the threegroups(x2=21.69,21.41,25.51,6.91,21.87,all P＜0.05).In addition,gait disturbance was increasingly aggravated with the severity of cognitive impairment.In SIVD-MCI group,urinary disorder,pseudobulbar palsy and falls were significantly increased as compared with SIVD-NCI group (x2 =15.57,16.31,8.92,both P＜0.017).Depression was statistically significant different between SIVD-NCIandSIVD-VaD group(x2 =6.90,P＜0.017).Among the three groups,there was no significant difference in the feature of emotional incontinence.Conclusions With the decline in cognitive function,the patients with SIVD can present with different clinical features of subcortical damage.Gait disturbance is gradually aggravated with the decline in cognitive function.Urinary disorder,pseudobulbar palsy,and falls can reflect the cognitive impairment from normal to mild on the other hand.Depression can be used as one of the signs that show cognitive impairment reached to dementia.