CAJ | 학술논문

目的探讨遗忘型轻度认知损害(amnestic mild cognitive impairment,aMCI)患者白质损害特点及其与认知功能的关系.方法采用总体认知功能评估和多维度神经心理学量表评估83例aMCI受试者及85名健康对照者,使用弥散张量成像技术及基于纤维示踪的空间统计方法分析两组白质差异区域及其与认知功能的相关性.结果与健康对照组相比,aMCI组在总体认知及各认知领域测验评分(分)包括简易精神状态量表(26.2±2.6与28.3±1.3,F=43.224,P=0.000)、Mattis痴呆评定量表(131.4±6.9与138.0±3.5,F=62.308,P=0.000)、听觉词语学习测验(2.4±1.6与7.5±2.0,F=324.018,P=0.000)、图片命名测试(8.7±1.4与9.2±1.0,F=6.821,P=0.010)、Rey-Osterrich复杂图形测验(12.1±7.3与18.5±6.1,F=40.674,P=0.000)、数字符号转换测验(30.0±10.1与38.6±9.8,F=30.786,P=0.000)、连线测验B[(256.8±124.5)s与(178.1±59.0)s,F=27.601,P=0.000]等都存在显著损害.aMCI组平均弥散率、径向弥散率值增高的区域包括双侧海马旁白质、上纵束、下纵束、上额枕束、下额枕束、钩束、皮质脊髓束、胼胝体、扣带及放射冠;除扣带和放射冠外,其他白质区域轴向弥散率值均增高;但部分各向异性值均无显著改变;双侧额叶下(左侧r=0.67,右侧r=0.70)、左侧扣带(r=0.63)及顶叶白质(r=0.69)的平均弥散率,左侧顶叶(r=0.68)径向弥散率参数与连线测试A评分结果呈正相关(均P＜0.05).结论 aMCI患者存在广泛的白质损害,缺乏脑区特异性的白质损害;其执行功能与额叶下、扣带及顶叶白质损害相关.弥散张量成像4个参数值反映白质病变的特异度、敏感度各不相同.临床试验注册江苏省临床研究中心(BL2013025)
목적 탐토유망형경도인지손해(amnestic mild cognitive impairment,aMCI)환자백질손해특점급기여인지공능적관계.방법 채용총체인지공능평고화다유도신경심이학량표평고83례aMCI수시자급85명건강대조자,사용미산장량성상기술급기우섬유시종적공간통계방법분석량조백질차이구역급기여인지공능적상관성.결과 여건강대조조상비,aMCI조재총체인지급각인지영역측험평분(분)포괄간역정신상태량표(26.2±2.6여28.3±1.3,F=43.224,P=0.000)、Mattis치태평정량표(131.4±6.9여138.0±3.5,F=62.308,P=0.000)、은각사어학습측험(2.4±1.6여7.5±2.0,F=324.018,P=0.000)、도편명명측시(8.7±1.4여9.2±1.0,F=6.821,P=0.010)、Rey-Osterrich복잡도형측험(12.1±7.3여18.5±6.1,F=40.674,P=0.000)、수자부호전환측험(30.0±10.1여38.6±9.8,F=30.786,P=0.000)、련선측험B[(256.8±124.5)s여(178.1±59.0)s,F=27.601,P=0.000]등도존재현저손해.aMCI조평균미산솔、경향미산솔치증고적구역포괄쌍측해마방백질、상종속、하종속、상액침속、하액침속、구속、피질척수속、변지체、구대급방사관;제구대화방사관외,기타백질구역축향미산솔치균증고;단부분각향이성치균무현저개변;쌍측액협하(좌측r=0.67,우측r=0.70)、좌측구대(r=0.63)급정협백질(r=0.69)적평균미산솔,좌측정협(r=0.68)경향미산솔삼수여련선측시A평분결과정정상관(균P＜0.05).결론 aMCI환자존재엄범적백질손해,결핍뇌구특이성적백질손해;기집행공능여액협하、구대급정협백질손해상관.미산장량성상4개삼수치반영백질병변적특이도、민감도각불상동.림상시험주책 강소성림상연구중심(BL2013025)
Objective To investigate the features of white matter impairment and its relationship with cognition in patients with amnestic mild cognitive impairment (aMCI).Methods Eighty-three cases of aMCI and 85 normal aging volunteers were scanned with diffusion tensor imaging (DTI) using MR system.All subjects completed the neuropsychological battery.We analyzed the differences between two groups using tract-based spatial statistics and the association between regions in difference and cognition using correlation analysis.Results There were significant differences between aMCI and normal control in the neuropsychological battery including the Mini-Mental State Examination(26.2 ± 2.6 vs 28.3 ± 1.3,F =43.224,P =0.000),Mattis Dementia Rating Scale-2 (131.4 ± 6.9 vs 138.0 ± 3.5,F =62.308,P =0.000),Auditory Verbal Learning Test-delayed recall(2.4 ± 1.6 vs 7.5 ± 2.0,F =324.018,P =0.000),Boston Naming Test(8.7 ± 1.4 vs 9.2 ± 1.0,F =6.821,P =0.010),Rey-Osterrich Complex Figure Test (12.1 ± 7.3 vs 18.5 ± 6.1,F =40.674,P =0.000),Symbol Digit Modulation Test (30.0 ± 10.1 vs 38.6 ± 9.8,F =30.786,P =0.000),Trail-Making Test Part B ((256.8 ± 124.5) s vs (178.1 ± 59.0) s,F =27.601,P =0.000).Significantly higher diffusivity indexes and radial diffusivity were also found in aMCI subjects compared to healthy elders in the parahippocampal,superior longitudinal fasciculus,inferior longitudinal fasciculus,superior fronto-occipital fasciculus,inferior fronto-occipital fasciculus,unciform fasciculus,corticospinal tract,corpus callosum,cingulum,corona radiate.We also found that axial diffusivity was significantly increased in the parahippocampal,superior longitudinal fasciculus,inferior longitudinal fasciculus,superior fronto-occipital fasciculus,inferior fronto-occipital fasciculus,unciform fasciculus,corticospinal tract and corpus callosum,whereas fractional anisotropy changes were not observed in aMCI.Diffusivity indexes values in bilateral frontal lobe (left r =0.67 ; right r =0.70),left cingulum (r =0.63),parietal white matter (r =0.69) and radial diffusivity values in left parietal (r =0.68) were significantly related to Trail Making Test A among aMCI (all P ＜ 0.05).Conclusions In aMCI patients,there was a wide range of white matter damage,with no brain region-specific.Executive function deficit was related to the white matter impairment in bilateral frontal lobe,left cingulate and parietal lobe.The specificity and sensitivity of four DTI parameters fordetecting white matter lesions are variant.Trial registration Clinical Research Center of Jiangsu Province (BL2013025)