本文選題：AD + 散發(fā)型CSVD　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景和目的認(rèn)知功能障礙泛指各種原因?qū)е碌牟煌潭鹊恼J(rèn)知功能損害。臨床上導(dǎo)致認(rèn)知功能障礙的疾病繁多,阿爾茨海默病(Alzheimer's disease,AD)和散發(fā)型腦小血管病(sporadic cerebral small disease,sporadic CSVD)是導(dǎo)致認(rèn)知功能障礙的常見類型。這兩種疾病均具有慢性進(jìn)行性認(rèn)知功能障礙、功能退化和行為異常等精神癥狀。高血壓、糖尿病、肥胖、高脂血癥等是散發(fā)型CSVD的血管因素,也常出現(xiàn)在AD患者中。人們對二者認(rèn)知功能的研究眾多,作者通過文弩獻(xiàn)閱讀發(fā)現(xiàn)二者所致的認(rèn)知功能障礙在不同認(rèn)知域有著不同的表現(xiàn)。本研究旨在比較AD及散發(fā)型CSVD所致的認(rèn)知障礙在不同認(rèn)知域中的差異性。材料與方法1.研究對象研究對象來源于2015.01-2017.01就診于山東大學(xué)齊魯醫(yī)院神經(jīng)內(nèi)科門診及病房的AD及散發(fā)型CSVD患者,收集患者一般資料、血液學(xué)檢查、簡易智能精神狀態(tài)檢查量表(mini-mental state examination,MMSE)及蒙特利爾認(rèn)知評估量表中文版(Montreal cognitive assessment scale,MoCA)評分。篩選出"很可能AD"組(AD組),"散發(fā)型CSVD"組(CSVD組),及同期正常對照組(Con組)人員,并對AD與散發(fā)型CSVD認(rèn)知功能障礙的差異性進(jìn)行分析。2.研究方法收集受試者相關(guān)病史,包括患者年齡、性別、受教育程度、吸煙、飲酒史以及高血壓、糖尿病、高脂血癥、高同型半胱氨酸血癥,對AD及散發(fā)型CSVD的危險因素進(jìn)行分析。根據(jù)MMSE及MoCA評分,對受試者定向力、即刻回憶、注意力、計算力、延遲回憶、語言、抽象能力、視空間覺及執(zhí)行能力進(jìn)行分析。3.數(shù)據(jù)分析采用SPSS22.0數(shù)據(jù)軟件對數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。其中,計量資料通過卡方檢驗進(jìn)行兩兩比較,計數(shù)資料通過非參數(shù)檢驗進(jìn)行兩兩比較。檢驗水平均為0.05。P0.05表示具有顯著性差異。結(jié)果1.一般資料本研究共納入"AD組"患者43例,"CSVD組"患者45例,"Con組"人員46例。各組在性別、教育年限、高脂血癥、高同型半胱氨酸血癥(高Hcy)、吸煙史、飲酒史上無統(tǒng)計學(xué)差異。CSVD組年齡、高血壓與糖尿病的患病率高于AD組及Con組。2.MMSE總分及子項目AD組與Con組相比,在MMSE總分、定向力、注意力與計算力、延遲回憶、書寫及視空間覺上有統(tǒng)計學(xué)差異,而在即刻回憶、命名、復(fù)述、閱讀及理解上無顯著性差異(見表2)。CSVD組與Con組相比,在MMSE總分、定向力、即刻記憶、注意力與計算力、延遲回憶、復(fù)述、理解、書寫及視空間覺上有統(tǒng)計學(xué)差異,而在命名與閱讀上則無統(tǒng)計學(xué)差異(見表3)。AD組與CSVD組相比,在定向力、注意力與計算力、及復(fù)述上存在統(tǒng)計學(xué)差異,而在MMSE總分、即刻記憶、延遲回憶、命名、閱讀、理解、書寫及視空間覺上無統(tǒng)計學(xué)差異(見表4)。3.MoCA總分及子項目AD組與Con組相比,在除命名與順背外所有的MoCA子項目中均具有明顯差異性(見表5)。CSVD組與Con組相比,在所有的MoCA子項目中均具有明顯差異性(見表6)。AD組與CSVD組相比,在MoCA總分、即刻回憶、復(fù)制立方體、畫鐘試驗、倒背、注意力、詞語流暢性、抽象及定向力上具有統(tǒng)計學(xué)差異,而在連線試驗、命名、順背、計算力、復(fù)述及延遲回憶上無統(tǒng)計學(xué)差異(見表7)。結(jié)論1、與AD相比,散發(fā)型CSVD所致認(rèn)知功能障礙與年齡、高血壓及糖尿病的關(guān)系更為密切。2、與AD相比,散發(fā)型CSVD所致的認(rèn)知功能障礙累及的認(rèn)知域更為廣泛;MoCA的得分也更低,說明MoCA在評估散發(fā)型CSVD認(rèn)知功能的敏感性高于MMSE。3、與AD相比,散發(fā)型CSVD所致的認(rèn)知功能障礙在命名、復(fù)述及自由回憶上的表現(xiàn)無差異;散發(fā)型CSVD在即刻記憶、計算力與注意力、詞語流暢性、f抽象思維和執(zhí)行功能領(lǐng)域上的損害更重,而在定向力上的表現(xiàn)明顯優(yōu)于AD。
[Abstract]:Background and objective cognitive dysfunction generally refers to the varying degrees of cognitive impairment caused by various causes. There are many clinical causes of cognitive impairment. Alzheimer's disease (AD) and diffuse cerebral small vascular disease (sporadic cerebral small disease, sporadic CSVD) are the common causes of cognitive dysfunction. These two diseases all have mental symptoms such as chronic progressive cognitive impairment, functional degeneration and abnormal behavior. Hypertension, diabetes, obesity, hyperlipidemia, etc. are the vascular factors of the scattered CSVD, and often appear in the patients with AD. The study of the cognitive function of the two persons is numerous, and the author finds two through the reading of the literary crossbow. Cognitive impairment was different in different cognitive domains. The purpose of this study was to compare the differences of cognitive impairment caused by AD and scattered CSVD in different cognitive domains. Material and methods 1. subjects were derived from the AD and distribution of 2015.01-2017.01 in the neurology clinic and ward of Qilu Hospital of Shandong University. Type CSVD patients were collected for general data, hematology, Mini-Mental State Examination (MMSE) and the Chinese version of the Montreal cognitive assessment scale (Montreal cognitive assessment scale, MoCA). An analysis of the differences in the cognitive impairment between AD and diffuse CSVD in the group (group Con) and the analysis of the related history of patients with.2. research, including age, sex, education, smoking, drinking history, hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia, and risk factors for AD and scattered CSVD. According to the MMSE and MoCA scores, the subjects' orientation, immediate memory, attention, computational power, delayed memory, language, abstract ability, visual spatial awareness and execution ability were analyzed for statistical analysis of.3. data using SPSS22.0 data software. Among them, the measurement data were compared by chi square test for 22 comparison, counting data 22 comparisons were made by nonparametric tests. The level of test was 0.05.P0.05. Results 1. general data included 43 cases of "group AD", 45 cases in group CSVD, and 46 cases of "group Con". All groups were in sex, years of education, hyperlipidemia, hyperhomocysteinemia (high Hcy), smoking history, and drinking history. Statistical difference in group.CSVD age, the prevalence of hypertension and diabetes was higher than that in group AD and group Con, and the total score of.2.MMSE in group Con and group AD were compared with that of group Con. There were significant differences in total MMSE score, orientation, attention and computational power, delayed recall, writing and visual space, while there was no significant difference in immediate recollection, naming, retelling, reading and understanding. Group.CSVD (see Table 2) compared with group Con, there were statistical differences in MMSE total score, orientation, immediate memory, attention and computational power, delayed recall, rehearsal, understanding, writing and visual space, but there was no statistical difference between naming and reading (see Table 3) the.AD group was compared with the CSVD group in orientation, attention and calculation, and rehearsal existence. There was no difference in MMSE total score, instant memory, delayed memory, naming, reading, reading, writing, and visual spatial awareness (see Table 4).3.MoCA total score and subproject AD, compared with the Con group, in all MoCA subprojects except the nomenclature and the CIS back (see Table 5).CSVD group in all MoCA subgroups compared with the Con group. There were significant differences in the project (see Table 6) the.AD group was compared with the CSVD group, and there was no statistical difference in the total score of MoCA, immediate recall, replicating cube, clock test, back, attention, fluency, abstraction and orientation, but there was no statistical difference in the connection test, naming, CIS back, computational force, rehearsal and delayed memory (Table 7). 1 conclusion 1 Compared with AD, the cognitive dysfunction caused by the diffuse CSVD was more closely related to age, hypertension and diabetes. Compared with AD, the cognitive impairment caused by the diffuse CSVD was more extensive, and the MoCA score was lower, indicating that the sensitivity of MoCA in evaluating the cognitive function of the scattered CSVD was higher than that of MMSE.3, compared with AD. The cognitive impairment caused by type CSVD has no difference in naming, retelling and free recollection; scattered CSVD has more damage in immediate memory, computational force and attention, fluency of words, f abstract thinking and executive function, while the performance of the orienteering is better than that of AD..
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.1

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