目的:分析腦小血管病性認(rèn)知功能障礙(CSVCI)與腦電改變的特點(diǎn),探討兩者之間的相關(guān)性,為早期發(fā)現(xiàn)腦小血管病認(rèn)知功能改變及監(jiān)測病情的變化提供客觀依據(jù)。方法:選取2015年01月~2017年01月于吉林大學(xué)白求恩第一醫(yī)院住院或記憶門診就診的CSVCI患者81例作為本課題的研究對象。記錄患者的臨床資料、神經(jīng)心理學(xué)測驗(yàn)評分及4小時(shí)錄像腦電圖(EEG)監(jiān)測結(jié)果。根據(jù)美國《精神疾病診斷和統(tǒng)計(jì)手冊》第4版(Ds M~IV)的診斷標(biāo)準(zhǔn),將研究對象分為2組:非癡呆性血管性認(rèn)知功能障礙組(VCIND)和血管性癡呆組(VaD)。使用SPSS19.0軟件進(jìn)行數(shù)據(jù)的統(tǒng)計(jì)學(xué)分析。結(jié)果:1、VCIND和VaD組在年齡、性別、受教育程度、有無高血壓、吸煙史、飲酒史、高脂血癥病史、糖尿病病史方面差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2、VCIND和VaD組在MMSE總分及分項(xiàng)評分、Mo CA總分及各認(rèn)知域評分、MES總分及分項(xiàng)評分相比(P0.05)有統(tǒng)計(jì)學(xué)差異。3、本課題81例研究對象中正常EEG為11.1%、輕度異常32.1%、中度異常48.1%、重度異常8.6%。VCIND組正常EEG為17.6%,輕度異常35.3%,中度異常47.1%,無重度異常EEG;與之對應(yīng)的VaD組分別為6.4%、29.8%、48.9%及14.9%。兩組間比較差異(P0.05)有統(tǒng)計(jì)學(xué)意義。4、CSVCI中正常EEG為11.1%、僅背景改變?yōu)?1.0%,僅異常波存在的為18.5%,兼有背景和異常波為49.4%。VCIND組正常EEG為17.6%,僅背景改變?yōu)?5.3%,僅異常波存在及兼有背景和異常波存在的EEG為23.5%;VaD組正常EEG為6.4%,僅背景改變?yōu)?0.6%,僅異常波存在為14.9%,兼有背景及異常波改變的EEG為68.1%。兩組間比較(P0.05)差異有統(tǒng)計(jì)學(xué)意義。5、81例研究對象中無異常波的EEG為32.1%,少量異常波EEG為27.2%,中量異常波的EEG為30.9%,大量異常波的EEG為9.9%。其中VCIND組分別為52.9%、32.4%、14.7%、0.0%;相對應(yīng)的VaD組分別是17.0%、23.4%、42.7%及17.0%。兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。6、比較VCIND組及VaD組EEG一般特征,VaD組較VCIND組腦電背景頻率變慢,背景腦電及局灶性慢波活動(dòng)增多,節(jié)律泛化、調(diào)節(jié)調(diào)幅異常及異常波的比例也增多,且統(tǒng)計(jì)學(xué)意義(P0.05)。7、正常EEG、輕度異常EEG、中度及重度異常EEG4組間對應(yīng)的MMSE評分(23.89±4.137 vs 22.15±5.936 vs 21.64±5.480 vs 14.43±4.577)、Mo CA評分(18.78±5.333 vs 16.58±5.907 vs 15.36±5.603 vs 8.57±1.272)、MES評分(63.14±17.790 vs 56.50±23.376 vs 54.57±22.909 vs 33.00±14.434)及ADL評分(26.22±6.037 vs 30.46±13.252 vs 31.36±12.592 vs 47.43±15.757)組間比較差異有統(tǒng)計(jì)學(xué)差異(P0.05)。無異常波、少量、中量及大量異常波存在的EEG4組間MMSE(24.65±4.039 vs 22.05±5.481 vs 19.88±5.630 vs 14.13±4.324)MOCA(18.69±4.488 vs 15.82±5.395 vs 14.24±6.112 vs 8.63±3.159)、MES(66.23±16.535 vs 57.42±20.868 vs 46.33±24.259 vs 34.38±17.808)、ADL(26.00±5.987 vs 29.95±13.415 vs 35.08±13.687 vs 46.38±17.533)的評分上相比較差異有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1、隨著疾病的發(fā)展,CSVCI患者的執(zhí)行功能、記憶功能及語言能力等各認(rèn)知域均有受損。2、CSVCI患者中EEG異常比例較高,且以輕、中度異常為主,隨著認(rèn)知功能障礙程度的加重,異常EEG的比例增多異常程度也加重。即EEG對CSVCI的診斷有較高的敏感性,并且能反應(yīng)認(rèn)知功能障礙的進(jìn)展。3、CSVCI患者EEG的改變可以是背景的改變、局灶性異常波或合并存在,VCIND中以背景改變?yōu)橹饕问?當(dāng)認(rèn)知障礙程度進(jìn)一步加重,則以背景及異常波合并存在為主。4、隨著認(rèn)知功能障礙程度的加重,腦電背景頻率變慢,背景腦電及局灶性慢波活動(dòng)增多,節(jié)律泛化、調(diào)節(jié)調(diào)幅異常及局灶性異常波的比例也增多。5、CSVCI患者的EEG局灶性改變中可以少量、中量或大量異常波,其中以少量及中量改變?yōu)橹�。隨著認(rèn)知障礙程度的加重,中量及大量異常波的EEG比例增多。6、EEG異常程度分級及異常波的數(shù)量均與認(rèn)知量表及日常生活能力表現(xiàn)有關(guān)。
Objective: To study the relationship between the changes of the cognitive function (CVCI) and the EEG in the brain, and to provide an objective basis for the early detection of the change of the cognitive function of the brain and the change of the monitoring condition. Methods:81 patients with CVCI who were admitted to the hospital or memory of the first hospital in Bethune, Jilin University from January 2015 to January 2017 were selected as the subject of this study. The patient's clinical data, the neuropsychological test scores, and the 4-hour Video Electroencephalogram (EEG) monitoring were recorded. The subjects were divided into two groups according to the diagnostic criteria of the American
Version 4 (Ds M-IV): a non-dementia vascular cognitive impairment group (VCIND) and a vascular dementia group (VaD). Statistical analysis of data was performed using the SPSS19.0 software. Results: There was no significant difference in the age, sex, the degree of education, the history of hypertension, the history of smoking, the history of drinking, the history of hyperlipidemia and the history of diabetes (P0.05). There was a statistical difference between the total scores of MES and the sub-item scores (P0.05).3. The normal EEG in 81 subjects in this study was 11.1%, slight abnormal 32.1%, moderate abnormal 48.1%, and severe abnormal 8.6%. The normal EEG of the VCIND group was 17.6%, the mild abnormality was 35.3%, the middle abnormality was 47.1%, and no severe abnormal EEG was found. The corresponding VaD groups were 6.4%, 29.8%, 48.9% and 14.9%, respectively. The difference between the two groups was statistically significant (P0.05).4. The normal EEG in the CVCI was 11.1%, only the background change was 21.0%, only the abnormal wave was 18.5%, and the background and the abnormal wave were 49.4%. The normal EEG of the VCIND group was 17.6%, and the background was only 35.3%. The EEG in the presence of only the abnormal wave and both the background and the abnormal wave was 23.5%; the normal EEG in the VaD group was 6.4%, only the background change was 10.6%, only the abnormal wave was 14.9%, and the EEG with both the background and the abnormal wave changed was 68.1%. There was statistical significance between the two groups (P0.05). The EEG of the non-abnormal wave in the 81 subjects was 32.1%, the EEG of the small abnormal wave was 27.2%, the EEG of the abnormal wave was 30.9%, and the EEG of the large number of abnormal waves was 9.9%. Of these, the VCIND groups were 52.9%, 32.4%, 14.7%, and 0.0%, respectively. The corresponding VaD groups were 17.0%, 23.4%, 42.7% and 17.0%, respectively. There was a significant difference between the two groups (P0.01).6. In comparison with the general characteristics of the EEG in the VCIND group and the VaD group, the frequency of the brain electrical background in the VaD group was slower, the background brain power and the focal slow wave activity increased, the rhythm was generalized, the proportion of the amplitude modulation abnormality and the abnormal wave was increased, and the statistical significance (P0.05). The corresponding MMSE scores between normal EEG, mild abnormal EEG, moderate and severe abnormal EEG4 groups (23.89, 4.137 vs. 22.15, 5.936 vs. 21.64, 5.480 vs. 14.43, 4.577), and Mo CA scores (18.78, 5.333 vs. 16.58, 5.907 vs. 15.36, 5.603 vs. 8.57, 1.272), The scores of MES (63.14-17.790 vs 56.50-23.376 vs. 54.57-22.909 vs. 33.00-14.434) and ADL (26.22-6.037 vs. 30.46-13.252 vs. 31.36-12.592 vs. 47.43-15.757) were statistically different (P0.05). MMSE (24.65-4.039 vs. 22.05-5.481 vs. 19.88-5.630 vs. 14.13-4.324) MOCA (18.69-4.488 vs 15.82-5.395 vs 14.24-6.112 vs. 8.63-3.159), MES (66.23-16.535 vs. 57.42-20.868 vs. 46.33-24.259 vs. 34.38-17.808), with no abnormal wave, small, medium and large number of abnormal waves. The scores of ADL (26.00-5.987 vs 29.95-13.415 vs 35.08-13.687 vs. 46.38-17.533) were statistically different (P0.05). Conclusion:1. With the development of the disease, the performance, memory function and language ability of the CVCI patients are impaired. The increase in the proportion of abnormal EEG was also increased. That is, the EEG has a high sensitivity to the diagnosis of CVCI and can reflect the progress of cognitive dysfunction.3. The change of the EEG in the CVCI patients can be the change of the background, the focal abnormal wave or the combined existence, the background of the VCIND changes to the main form, and when the degree of cognitive impairment is further increased, 4. With the increase of the degree of cognitive impairment, the background frequency of the EEG is slow, the background of the brain and the focal slow wave are increased, the rhythm is generalized, the regulation of the amplitude modulation and the proportion of the focal abnormal wave are also increased. There may be a small, medium or large number of abnormal waves in the EEG focal change of the CVCI patients, with a small amount and a moderate amount of change. With the increase of the degree of cognitive impairment, the proportion of EEG in the middle and the large number of abnormal waves was increased.6, The degree of abnormal EEG and the number of abnormal waves were related to the cognitive scale and the ability of daily life.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.13
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