本文選題：腦白質(zhì)疏松 + 側(cè)腦室后角旁白質(zhì)疏松�。� 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：背景及目的隨著顱腦計(jì)算機(jī)斷層掃描(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)的廣泛應(yīng)用,腦白質(zhì)疏松(leukoaraiosis,LA)越來越多地在中、老年人中被發(fā)現(xiàn)。目前大量研究表明腦白質(zhì)疏松與認(rèn)知功能損害相關(guān),無論是直接導(dǎo)致認(rèn)知損害還是由皮質(zhì)萎縮所介導(dǎo),普遍認(rèn)為是血管性癡呆和阿茲海默病的獨(dú)立性危險(xiǎn)因素。但是,早期局部腦白質(zhì)(孤立性半卵圓區(qū)、側(cè)腦室前角旁、后角旁或室體旁白質(zhì)疏松)是否對認(rèn)知功能造成損害,以及不同部位腦白質(zhì)疏松造成的認(rèn)知損害特點(diǎn)仍然不十分清楚,故本研究篩選臨床上常見的、早期的、局灶性白質(zhì)疏松,孤立性側(cè)腦室后角旁白質(zhì)疏松(occipital periventricular leukoaraiosis,OPVL)受試者為研究對象,探討其對認(rèn)知功能的影響及其神經(jīng)心理特征,以期據(jù)此初步提出腦白質(zhì)疏松相關(guān)認(rèn)知功能損害的神經(jīng)心理重點(diǎn)測評指標(biāo)和測評方案,以及與其他明確病因引起的認(rèn)知功能損害的鑒別診斷,從而為早期干預(yù)提供依據(jù)。方法采用病例對照研究,納入符合標(biāo)準(zhǔn)的第三軍醫(yī)大學(xué)新橋醫(yī)院神經(jīng)內(nèi)科病例。通過顱腦MRI檢查結(jié)果篩選出僅有側(cè)腦室后角旁3~13 mm范圍損害的孤立性側(cè)腦室后角旁白質(zhì)疏松受試者30例為后角組(posterior horn group,PHG)、大腦半球多部位存在腦白質(zhì)疏松的受試者32例作為混合組(mixed grou,MG)以及經(jīng)顱腦MRI證實(shí)無腦實(shí)質(zhì)結(jié)構(gòu)性改變的受試者33例作為對照組(controls,CN),三組受試者在人口統(tǒng)計(jì)學(xué)、腦血管病主要危險(xiǎn)因素等一般臨床資料相匹配。對三組受試者分別行神經(jīng)心理量表測評。使用簡易精神狀態(tài)量表(mini-mental state examination,MMSE)和蒙特利爾認(rèn)知評估量表(Montreal cognitive assessment,Mo CA北京版)評價(jià)受試者總體認(rèn)知功能數(shù)字廣度測驗(yàn)(digit span test,DST)評估注意能力。臨床記憶量表(clinical memory scale,CMS甲式)評估記憶能力。對比分析側(cè)腦室后角旁白質(zhì)疏松對認(rèn)知功能的影響及其神經(jīng)心理學(xué)特征。結(jié)果后角組與對照組相比,后角組的MMSE和MoCA總分較低(P0.01),短時(shí)記憶、延遲記憶、指向記憶、定向力和語言能力單項(xiàng)評分也明顯降低(P0.05,P0.01),而其他方面認(rèn)知單項(xiàng)評分差異無統(tǒng)計(jì)學(xué)意義(P0.05)�；旌辖M與對照組相比,MMSE和MoCA總分較低(P0.01),記憶力、定向力、語言能力、注意力、視覺空間與執(zhí)行和抽象認(rèn)知單項(xiàng)評分也明顯降低(P0.05,P0.01)。后角組與混合組相比,后角組抽象認(rèn)知、延遲記憶力、圖像自由回憶和人像特點(diǎn)聯(lián)系回憶評分顯著較高(P0.05,P0.01),其他認(rèn)知方面單項(xiàng)評分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論孤立性側(cè)腦室后角旁白質(zhì)疏松導(dǎo)致以定向力、記憶力和語言能力減退為特征的認(rèn)知功能損害。
[Abstract]:Background and objective with the wide application of computed tomographic CT (CT) and magnetic resonance imaging (MRI), leukoaraiosisla (leukoaraiosisla) is more and more common in the aged. At present, a large number of studies have shown that leukoaraiosis is associated with cognitive impairment, whether directly resulting in cognitive impairment or mediated by cortical atrophy. It is generally considered as an independent risk factor for vascular dementia and Alzheimer's disease. However, whether the early local white matter (solitary semicircular area, paraventricular anterior horn, posterior horn or paraventricular leukoaraiosis) has impaired cognitive function, And the characteristics of cognitive impairment caused by leukoaraiosis in different parts of the brain are still unclear, so this study screening common clinical, early, focal leukoaraiosis, The subjects of isolated parietal periventricular leukoaraiosissis OPVL in the posterior horn of the lateral ventricle were studied to investigate their effects on cognitive function and neuropsychological characteristics. In order to put forward the key neuropsychological evaluation index and evaluation scheme of cognitive impairment related to leukoaraiosis, and the differential diagnosis of cognitive impairment caused by other definite etiology, so as to provide the basis for early intervention. Methods A case-control study was carried out in the Department of Neurology, Xinqiao Hospital, third military Medical University. According to the results of craniocerebral MRI examination, 30 subjects with isolated lateral ventricular posterior horn leukoaraiosis were selected as posterior horn group PHG, and white matter osteoporosis was found in many parts of the cerebral hemispheres. The results of brain MRI examination showed that 30 subjects with isolated lateral ventricular posterior horn leukoaraiosis had only 3 mm damage in the posterior horn of the lateral ventricle. There were 32 cases as mixed group and 33 cases as control group with structural changes of brain parenchyma confirmed by craniocerebral MRI. The main risk factors of cerebrovascular disease were matched with other general clinical data. Three groups of subjects were assessed with neuropsychological scale. The mini-mental state examination (MMSE) and the Montreal cognitive assessment (MMSE) were used to evaluate the attention ability of the subjects using the digit span test of total cognitive function (digit span test). Clinical memory scale was used to evaluate memory ability. The effects of leukoaraiosis in the posterior horn of lateral ventricle on cognitive function and its neuropsychological characteristics were analyzed. Results compared with the control group, the total scores of MMSE and MoCA in the posterior horn group were lower than those in the control group, and the scores of short-term memory, delayed memory, directed memory, directional ability and language ability were significantly lower than those in the control group, but there was no significant difference in other cognitive individual scores. Compared with the control group, the total scores of MMSE and MoCA in the mixed group were significantly lower than those in the control group (P 0.01). The scores of memory, orientation, language ability, attention, visual space and executive and abstract cognitive items were also significantly lower than those in the control group (P 0.05 and P 0.01). In the posterior horn group, the scores of abstract cognition, delayed memory, image free recall and the associative recall of human image characteristics were significantly higher than those in the mixed group, but there was no significant difference in other cognitive individual scores (P 0.05). Conclusion isolated leukoaraiosis in the posterior horn of the lateral ventricle leads to cognitive impairment characterized by decreased orientation, memory and language ability.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李海華;李雪蓮;代政偉;胡振龍;陳甜;文鵬程;;不同程度腦白質(zhì)疏松癥患者認(rèn)知功能的對比研究[J];重慶醫(yī)學(xué);2014年17期

2 孫洪吉;謝越;張曉紅;解恒革;吳衛(wèi)平;;蒙特利爾認(rèn)知評估量表在健康體檢人群中的應(yīng)用[J];中華老年心腦血管病雜志;2014年02期

3 吳修信;李立新;黃志勇;廖品君;;尼莫地平與多奈哌齊治療皮質(zhì)下缺血性血管性認(rèn)知功能障礙患者的臨床療效觀察[J];血栓與止血學(xué);2012年05期

4 彭超英;解恒革;李金梅;;腦白質(zhì)疏松癥相關(guān)因素的多因素回歸分析[J];中國康復(fù)理論與實(shí)踐;2009年07期

5 趙建功;王偉;劉尖尖;黃光;;程度不同腦白質(zhì)疏松癥患者認(rèn)知功能特點(diǎn)研究[J];中國康復(fù)理論與實(shí)踐;2008年04期

6 李舜偉;;認(rèn)知功能障礙的診斷與治療[J];中國神經(jīng)精神疾病雜志;2006年02期

7 王新德;老年期癡呆──癡呆的定義、分類、診斷和鑒別診斷[J];中國實(shí)用內(nèi)科雜志;2000年12期

8 “臨床記憶量表”編制協(xié)作組;“臨床記憶量表”的編制[J];心理學(xué)報(bào);1986年01期

9 湯毓華;張明園;;漢密頓抑郁量表(HAMD)[J];上海精神醫(yī)學(xué);1984年02期

10 修訂韋氏成人智力量表全國協(xié)作組;韋氏成人智力量表的修訂[J];心理學(xué)報(bào);1983年03期

，

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