本文選題：輕度認(rèn)知功能障礙 + Alzheimer　； 參考：《臨床神經(jīng)病學(xué)雜志》2017年04期

【摘要】：目的探討皮質(zhì)下小血管病源性輕度認(rèn)知障礙(MCI-SVD)和Alzheimer's病源性輕度認(rèn)知障礙(MCI-AD)患者的血管危險(xiǎn)因素、腦動(dòng)脈粥樣硬化和腦解剖結(jié)構(gòu)的特征。方法收集48例MCI-SVD患者、40例MCI-AD患者和59名老年對(duì)照者的臨床資料。采用臨床癡呆評(píng)定量表(CDR)和蒙特利爾認(rèn)知評(píng)估(MoCA)中文版對(duì)患者進(jìn)行認(rèn)知功能評(píng)估。于入院后采用彩色多普勒超聲對(duì)患者進(jìn)行檢查,記錄左側(cè)及右側(cè)頸內(nèi)動(dòng)脈內(nèi)膜厚度、斑塊積分(Crouse積分)以及頸內(nèi)動(dòng)脈末段、大腦中動(dòng)脈、大腦前動(dòng)脈、大腦后動(dòng)脈、椎動(dòng)脈、基底動(dòng)脈(BA)的平均血管搏動(dòng)指數(shù)(MPI)。同時(shí)采用線性測(cè)量方法采集患者頭顱MRI的腦解剖結(jié)構(gòu)數(shù)據(jù)。結(jié)果與對(duì)照組比較,MCI-AD組、MCI-SVD組高血壓、糖尿病、吸煙的比率顯著升高,Mo CA評(píng)分顯著降低;MCIAD組低密度脂蛋白膽固醇、載脂蛋白B水平顯著降低(P0.05~0.01)。MCI-AD組和MCI-SVD組各血管危險(xiǎn)因素差異均無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05)。與對(duì)照組比較,MCI-AD組患者視空間和執(zhí)行功能、注意、計(jì)算、抽象、延遲回憶、畫(huà)鐘評(píng)分均顯著降低(P0.05~0.01);MCI-SVD組視空間和執(zhí)行功能,注意、計(jì)算、抽象、延遲回憶、畫(huà)鐘、定向均顯著降低(均P0.01)。MCI-AD組視力空間和執(zhí)行功能評(píng)分顯著高于MCI-SVD組(P0.05)。與對(duì)照組比較,MCI-SVD組Crouse積分和BA MPI顯著增高(均P0.05)。與對(duì)照組比較,MCIAD組患者最寬腦溝值、海馬溝回比及MCI-SVD組第三腦室和尾狀核指數(shù)顯著升高(均P0.01)。MCI-AD組最寬腦溝值顯著高于MCI-SVD組(P0.05)。結(jié)論 MCI-AD和MCI-SVD均表現(xiàn)為多領(lǐng)域認(rèn)知功能的減退。MCI-AD患者皮質(zhì)和海馬顯著萎縮,反映了記憶相關(guān)的海馬-內(nèi)側(cè)顳葉功能通路破壞;MCI-SVD患者皮質(zhì)下萎縮,可能由于額葉-皮質(zhì)下環(huán)路的破壞導(dǎo)致認(rèn)知障礙。兩者比較,MCI-SVD患者執(zhí)行功能損害更顯著,而MCI-AD患者皮質(zhì)萎縮更顯著。
[Abstract]:Objective to investigate the vascular risk factors, cerebral atherosclerosis and brain anatomical structure in patients with subcortical microvascular pathogenetic mild cognitive impairment (MCI-SVD) and Alzheimer's with mild cognitive impairment (Alzheimer's). Methods the clinical data of 48 patients with MCI-SVD, 40 patients with MCI-AD and 59 elderly controls were collected. The Chinese version of Clinical dementia rating scale (CDR) and Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function of the patients. The left and right internal carotid artery intima thickness, plaque score and Crouse score were recorded by color Doppler ultrasound after admission. The final segment of the internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the posterior cerebral artery, the vertebral artery, the posterior cerebral artery, and the vertebral artery were recorded. The mean pulsatile index (MPI) of the basilar artery (BAB). At the same time, the brain anatomical structure data of head MRI were collected by linear measurement method. Results compared with the control group, the ratio of hypertension, diabetes, smoking in MCI-SVD group was significantly higher than that in the control group. The level of apolipoprotein B decreased significantly (P 0.05). There was no significant difference in vascular risk factors between MCI-AD group and MCI-SVD group (all P 0.05). Compared with the control group, the visual space and executive function, attention, calculation, abstraction, delayed recall, and clock drawing scores in MCI-AD group significantly decreased the visual space and executive function, attention, calculation, abstraction, delayed recall, clock drawing in MCI-SVD group. The visual acuity and executive function scores of MCI-AD group were significantly higher than that of MCI-SVD group. Compared with the control group, the Crouse score and BA MPI in MCI-SVD group were significantly higher than those in the control group (P 0.05). Compared with the control group, the widest cerebral sulcus, the hippocampal sulcus ratio and the index of the third ventricle and caudate nucleus in MCI-SVD group were significantly higher than those in MCI-SVD group (P 0.01). MCI-AD group was significantly higher than that in MCI-SVD group (P 0.05). Conclusion both MCI-AD and MCI-SVD showed significant atrophy of cortex and hippocampus in patients with multi-domain cognitive impairment. The results indicated that the memory related functional pathway of hippocampal medial temporal lobe destroyed subcortical atrophy in patients with MCI-SVD. Cognitive impairment may result from the destruction of the frontal-subcortical loop. The impairment of executive function was more significant in patients with MCI-SVD than that in patients with MCI-SVD, and cortical atrophy was more significant in patients with MCI-AD.
【作者單位】： 蘇州大學(xué)附屬第一醫(yī)院老年病科;蘇州大學(xué)附屬第一醫(yī)院神經(jīng)內(nèi)科;
【分類(lèi)號(hào)】：R749.1
，

本文編號(hào)：1999317