中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
13期
984-989
,共6页
雷宇%郭起浩%李彦江%江汉强%倪伟%顾宇翔
雷宇%郭起浩%李彥江%江漢彊%倪偉%顧宇翔
뢰우%곽기호%리언강%강한강%예위%고우상
脑%缺血性病变%痴呆,血管性%神经心理学测验
腦%缺血性病變%癡呆,血管性%神經心理學測驗
뇌%결혈성병변%치태,혈관성%신경심이학측험
Brain%Ischemia%Dementia,vascular%Neuropsychological tests
目的 分析成人缺血性脑血管病患者的认知损害以为其诊治提供依据.方法 连续收集2012年6月至2013年6月在复旦大学附属华山医院神经外科就诊的缺血性脑血管病患者的临床资料,选取其中符合研究标准的患者56例,使用简易精神状态量表(MMSE)及记忆与执行筛查量表(MES)进行血管性认知损害(VCI)筛查.根据筛查结果将病例组分为3组:血管性痴呆亚组11例(VaD亚组)、血管性轻度认知损害亚组22例(VaMCI亚组)及无认知损害亚组23例(非VCI亚组),比较3组的一般情况;利用成套神经心理学量表分析VaMCI亚组的认知损害特征;根据病例组VCI的组成比分析缺血性脑卒中或短暂性脑缺血发作(TIA)与VCI各成分的关系.结果 病例组和匹配的48名健康对照在年龄、性别和受教育年限的差异无统计学意义(P＞0.05),病例组MMSE分数[(25.0±5.6)分比(28.0±1.4)分,P=0.007]和MES分数[(67±21)分比(84±7)分,P＜0.001]均显著低于健康对照组.病例组中33例(58.9％)存在VCI,包括VaD亚组11例(19.6％),VaMCI亚组22例(39.3％)及非VCI亚组23例(41.1％),VaD/VaMCI为1/2;VaD亚组男性比例(36.4％比78.3％,P=0.017)和受教育年限[(8±3)年比(12±4)年,P=0.010]均显著低于非VCI亚组;VaMCI亚组受教育年限[(7±3)年比(12±4)年;P =0.001]显著低于非VCI亚组;3个亚组的MMSE和MES分数与认知损害严重程度符合良好.本研究使用的整套神经心理学评估量表具有较好的敏感性和特异性,所有VaMCI患者(22例)均在至少一种执行功能/注意力测试中得分较低,21例(95.5％)在至少一种记忆测试中得分较低,17例(77.3％)在至少一种语言测试中得分较低,16例(72.7％)在至少一种视空间功能测试中得分较低;所有VaMCI患者均表现为2个以上认知域不同程度受损,其中50％为4个认知域均受损,45％为3个认知域均受损,余5％为2个认知域受损.病例组中各亚组的缺血性脑卒中发生率差异无统计学意义(x2=1.111,P=0.574);所有30例缺血性脑卒中患者中,56.7％为VCI,VaMCI/VCI为58.8％;26例TIA患者中,61.5％为VCI,VaMCI/VCI为75.0％.结论 使用量表对成人缺血性脑血管病的认知损害特征进行分析不仅可加深对疾病的理解,同时为VCI的诊断标准和分型等进一步研究提供可靠依据.
目的 分析成人缺血性腦血管病患者的認知損害以為其診治提供依據.方法 連續收集2012年6月至2013年6月在複旦大學附屬華山醫院神經外科就診的缺血性腦血管病患者的臨床資料,選取其中符閤研究標準的患者56例,使用簡易精神狀態量錶(MMSE)及記憶與執行篩查量錶(MES)進行血管性認知損害(VCI)篩查.根據篩查結果將病例組分為3組:血管性癡呆亞組11例(VaD亞組)、血管性輕度認知損害亞組22例(VaMCI亞組)及無認知損害亞組23例(非VCI亞組),比較3組的一般情況;利用成套神經心理學量錶分析VaMCI亞組的認知損害特徵;根據病例組VCI的組成比分析缺血性腦卒中或短暫性腦缺血髮作(TIA)與VCI各成分的關繫.結果 病例組和匹配的48名健康對照在年齡、性彆和受教育年限的差異無統計學意義(P＞0.05),病例組MMSE分數[(25.0±5.6)分比(28.0±1.4)分,P=0.007]和MES分數[(67±21)分比(84±7)分,P＜0.001]均顯著低于健康對照組.病例組中33例(58.9％)存在VCI,包括VaD亞組11例(19.6％),VaMCI亞組22例(39.3％)及非VCI亞組23例(41.1％),VaD/VaMCI為1/2;VaD亞組男性比例(36.4％比78.3％,P=0.017)和受教育年限[(8±3)年比(12±4)年,P=0.010]均顯著低于非VCI亞組;VaMCI亞組受教育年限[(7±3)年比(12±4)年;P =0.001]顯著低于非VCI亞組;3箇亞組的MMSE和MES分數與認知損害嚴重程度符閤良好.本研究使用的整套神經心理學評估量錶具有較好的敏感性和特異性,所有VaMCI患者(22例)均在至少一種執行功能/註意力測試中得分較低,21例(95.5％)在至少一種記憶測試中得分較低,17例(77.3％)在至少一種語言測試中得分較低,16例(72.7％)在至少一種視空間功能測試中得分較低;所有VaMCI患者均錶現為2箇以上認知域不同程度受損,其中50％為4箇認知域均受損,45％為3箇認知域均受損,餘5％為2箇認知域受損.病例組中各亞組的缺血性腦卒中髮生率差異無統計學意義(x2=1.111,P=0.574);所有30例缺血性腦卒中患者中,56.7％為VCI,VaMCI/VCI為58.8％;26例TIA患者中,61.5％為VCI,VaMCI/VCI為75.0％.結論 使用量錶對成人缺血性腦血管病的認知損害特徵進行分析不僅可加深對疾病的理解,同時為VCI的診斷標準和分型等進一步研究提供可靠依據.
목적 분석성인결혈성뇌혈관병환자적인지손해이위기진치제공의거.방법 련속수집2012년6월지2013년6월재복단대학부속화산의원신경외과취진적결혈성뇌혈관병환자적림상자료,선취기중부합연구표준적환자56례,사용간역정신상태량표(MMSE)급기억여집행사사량표(MES)진행혈관성인지손해(VCI)사사.근거사사결과장병례조분위3조:혈관성치태아조11례(VaD아조)、혈관성경도인지손해아조22례(VaMCI아조)급무인지손해아조23례(비VCI아조),비교3조적일반정황;이용성투신경심이학량표분석VaMCI아조적인지손해특정;근거병례조VCI적조성비분석결혈성뇌졸중혹단잠성뇌결혈발작(TIA)여VCI각성분적관계.결과 병례조화필배적48명건강대조재년령、성별화수교육년한적차이무통계학의의(P＞0.05),병례조MMSE분수[(25.0±5.6)분비(28.0±1.4)분,P=0.007]화MES분수[(67±21)분비(84±7)분,P＜0.001]균현저저우건강대조조.병례조중33례(58.9％)존재VCI,포괄VaD아조11례(19.6％),VaMCI아조22례(39.3％)급비VCI아조23례(41.1％),VaD/VaMCI위1/2;VaD아조남성비례(36.4％비78.3％,P=0.017)화수교육년한[(8±3)년비(12±4)년,P=0.010]균현저저우비VCI아조;VaMCI아조수교육년한[(7±3)년비(12±4)년;P =0.001]현저저우비VCI아조;3개아조적MMSE화MES분수여인지손해엄중정도부합량호.본연구사용적정투신경심이학평고량표구유교호적민감성화특이성,소유VaMCI환자(22례)균재지소일충집행공능/주의력측시중득분교저,21례(95.5％)재지소일충기억측시중득분교저,17례(77.3％)재지소일충어언측시중득분교저,16례(72.7％)재지소일충시공간공능측시중득분교저;소유VaMCI환자균표현위2개이상인지역불동정도수손,기중50％위4개인지역균수손,45％위3개인지역균수손,여5％위2개인지역수손.병례조중각아조적결혈성뇌졸중발생솔차이무통계학의의(x2=1.111,P=0.574);소유30례결혈성뇌졸중환자중,56.7％위VCI,VaMCI/VCI위58.8％;26례TIA환자중,61.5％위VCI,VaMCI/VCI위75.0％.결론 사용량표대성인결혈성뇌혈관병적인지손해특정진행분석불부가가심대질병적리해,동시위VCI적진단표준화분형등진일보연구제공가고의거.
Objective To explore the characteristics of cognitive impairment of cerebral ischemia in adults to provide rationales for proper diagnosis and targeted treatment.Methods A battery of standardized neuropsychological tests including mini-mental state examination (MMSE) and memory and executive screening (MES) was administered in a cohort of consecutive patients with cerebral ischemia.According to the screening results,they were divided into 3 subgroups of vascular dementia (VaD),vascular mild cognitive impairment (VaMCI) and non-vascular cognitive impairment (VCI).The general profiles of 3 subgroups were compared and the characteristics of VaMCI subgroup examined.Then the relationship between the composition of cognitive impairment and the type of ischemia (stroke and transient ischemic attack) was analyzed.Results Fifty-six patients and 48 healthy subjects (normal control group) matched with regards to age,gender and education were recruited.Compared to normal control group,there was a decline in the scores of MMSE [(25.0 ±5.6) vs (28.0 ± 1.4) ; t =2.695,P =0.007] and MES [(67 ±21) vs (84 ± 7) ; z =3.860,P =0.000] in case group.There were 33 cases (58.9％) of VCI in case group,including 11 (19.6％) in VaD subgroup,22 (39.3％) in VaMCI subgroup and 23 (41.1％) in non-VCI subgroup.And the rate of VaD/VaMCI was 1/2.The percentage of males (36.4％ vs 78.3 ％ ; x2 =5.720,P =0.017) and education [(8 ± 3) vs (12 ± 4) ; P =0.010] of VaD subgroup were significantly lower than that of non-VCl subgroup; the education of VaMCI subgroup was significantly lower than that of non-VCI subgroup [(7 ± 3) vs (12 ± 4) ; P =0.001] ; a positive correlation existed between scores of MMSE/MES and cognitive impairment.The neuropsychological tests were both sensitive and specific.In VaMCI subgroup,22 cases (100％) presented with a deficit of at least 1 certain executive function/attention index,21 (95.5％) with at least 1 certain memory index,17(77.3％) with at least 1 certain language index and 16 (72.7％) with at least 1 certain visuospatial function index; all VaMCI cases presented with comprehensive cognitive impairment:11 (50％) in 4 domains,10 (45％) in 3 domains and 1 (5％) in 2 domains.No significant difference existed among 3 subgroups with regard to type of ischemia (x2 =1.111,P =0.574).In the case group,30 patients suffered stroke and 17 (56.7％) had an onset of VCI with a rate of VaMCI/ VCI at 58.8％ ; transient ischemic attack occurred in 26 patients and 16 (61.5％) suffered VCI with a rate of VaMCI/VCI at 75.0％.Conclusion Our study not only profiles the prevalence and peculiarity of cognitive impairment in patients with cerebral ischemia,but also provides concrete rationales for further diagnosis and classification of VCI.
