發(fā)布時(shí)間：2018-05-03 23:16

  本文選題：皮質(zhì)下缺血性血管病 + 神經(jīng)心理學(xué)��； 參考：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的采用神經(jīng)心理學(xué)量表，探討皮質(zhì)下缺血性血管�。⊿IVD）的神經(jīng)心理學(xué)特征；應(yīng)用一系列量表并結(jié)合臨床表現(xiàn)對(duì)SIVD的皮質(zhì)下特征進(jìn)行評(píng)估，進(jìn)一步探討SIVD的認(rèn)知損害與皮質(zhì)下特征之間的關(guān)系。 材料與方法對(duì)受試對(duì)象采用一系列神經(jīng)心理學(xué)量表檢查，包括簡(jiǎn)易智能狀態(tài)量表（MMSE）、蒙特利爾認(rèn)知評(píng)估量表（MoCA）、劍橋老年認(rèn)知檢查量表中文版（CAMCOG-C）、畫鐘試驗(yàn)（CDT）及日常生活能力（ADL）等，并結(jié)合頭顱MRI，最終選擇110例SIVD為研究對(duì)象入組，通過對(duì)所有受試者的神經(jīng)心理學(xué)量表的測(cè)試將SIVD的認(rèn)知分為三組，即34例認(rèn)知正常（SIVD-NCI）、47例伴有輕度認(rèn)知損害（SIVD-MCI）、29例癡呆（SIVD-VaD）。對(duì)所有入組的受試對(duì)象均進(jìn)行是否存在皮質(zhì)下特征的評(píng)估。步態(tài)平衡能力采用計(jì)時(shí)“起立—行走”測(cè)試（TUG）；排尿功能、假性球麻痹、情感失禁及跌倒等皮質(zhì)下特征的評(píng)估主要與臨床表現(xiàn)相結(jié)合；抑郁癥狀采用老年抑郁量表（GDS）測(cè)評(píng)。比較三組間認(rèn)知和日常生活能力的評(píng)分，，并對(duì)SIVD認(rèn)知損害的不同階段伴隨的皮質(zhì)下特征進(jìn)行分析。 結(jié)果（1）三組研究對(duì)象的性別、年齡及受教育程度等社會(huì)人口因素均無統(tǒng)計(jì)學(xué)意義；在血管危險(xiǎn)因素方面，高血壓病、高脂血癥、心臟病、糖尿病患病率及吸煙率等方面差異均無統(tǒng)計(jì)學(xué)意義。（2）SIVD-VaD組（18.1±3.9；13.8±3.8；64.7±12.3；4.0±2.6）和SIVD-MCI組（24.5±2.4；18.5±4.0；78.5±11.3；5.6±2.8）MMSE、MoCA、COMCOG-C、CDT評(píng)分均顯著低于SIVD-NCI組（28.4±1.2；23.2±3.0；92.1±6.5；8.0±2.5）（均P0.05），SIVD-VaD組的MMSE、MoCA、COMCOG-C、CDT評(píng)分均顯著低于SIVD-MCI組（P0.05）；SIVD-VaD組（42.8±16.0）和SIVD-MCI組（30.6±11.2）ADL量表評(píng)分均顯著高于SIVD-NCI組（22.7±5.2）（均P0.05），SIVD-VaD組的ADL量表評(píng)分顯著高于SIVD-MCI組（P0.05）。（3）步態(tài)障礙、排尿障礙、假性延髓麻痹、抑郁、跌倒等皮質(zhì)下特征在三組間有統(tǒng)計(jì)學(xué)意義（χ2=21.696、21.412、25.512、6.913、21.871，均P0.05）。其中步態(tài)障礙隨著認(rèn)知損害程度加重而進(jìn)一步加重；SIVD-MCI組排尿障礙、假性延髓麻痹及跌倒等皮質(zhì)下特征較SIVD-NCI組顯著增多（χ2=15.570、16.305、8.924，均P0.05）；抑郁在SIVD-NCI及SIVD-VaD組之間有統(tǒng)計(jì)學(xué)意義（χ2=6.901，P0.017）。皮質(zhì)下特征中的情感失禁在三組之間無統(tǒng)計(jì)學(xué)差異。 結(jié)論 ⑴SIVD隨著認(rèn)知功能的下降而伴隨著不同的皮質(zhì)下特征。 ⑵步態(tài)障礙隨著認(rèn)知功能的下降而進(jìn)一步加重；排尿障礙、假性球麻痹及跌倒等皮質(zhì)下特征可反映認(rèn)知由正常到損害的分水嶺；抑郁癥狀可反映SIVD認(rèn)知功能損害是否達(dá)到癡呆程度。 ⑶SIVD患者出現(xiàn)不同的皮質(zhì)下特征時(shí)我們可以預(yù)測(cè)認(rèn)知是否損害并較早地干預(yù)及改善日常生活能力。
[Abstract]:Objective to investigate the neuropsychological characteristics of subcortical ischemic vascular disease (SIVD) with neuropsychological scale, and to evaluate the subcortical characteristics of SIVD with a series of scales and clinical manifestations. To further explore the relationship between SIVD cognitive impairment and subcortical features. Materials and methods subjects were examined with a series of neuropsychological scales, including MMSE, MoCAA, CAMCOG-CX, CDT and ADL. Combined with cranial MRI, 110 cases of SIVD were selected as the study subjects. The cognition of SIVD was divided into three groups by measuring the neuropsychological scale of all subjects, namely, 34 cases of normal cognition with SIVD-NCII 47 cases with mild cognitive impairment and 29 cases of dementia with SIVD-VaDD. All subjects were assessed for subcortical features. Gait balance was measured by standing up and walking test, subcortical features such as urination function, pseudobulbar paralysis, emotional incontinence and fall were mainly evaluated with clinical manifestation, and depressive symptoms were evaluated by GDSs. The scores of cognitive and ADL were compared among the three groups, and the subcortical features associated with different stages of SIVD cognitive impairment were analyzed. Results (1) there was no significant difference in sex, age, education and other social and demographic factors among the three groups, and in vascular risk factors, hypertension, hyperlipidemia, heart disease, hypertension, hypertension, hyperlipidemia, heart disease, hypertension, hyperlipidemia, heart disease, and so on. 緋栧翱鐥呮?zhèn)ｇ梾鐜囧強(qiáng)鍚哥儫鐜嚱{夋柟闈㈠樊寮傚潎鏃犵粺璁″鎰忎箟.(2)SIVD-VaD緇

本文編號(hào)：1840528