血管源性輕度認知障礙的AD8、Cog12篩查及~1H-MRS特點研究
發(fā)布時間：2018-08-05 20:09
【摘要】：研究目的 1.通過對認知正常者、血管性癡呆（vascular dementia，VD）和血管源性輕度認知障礙（vascular mild cognitive impairment，v-MCI）患者進行一系列神經(jīng)心理學(xué)量表測驗，探討AD8（Alzheimer disease8）、Cog12（cognitive impairment assessment scale12）在v-MCI篩查中的應(yīng)用價值。 2.通過對v-MCI患者和認知正�；颊哌M行質(zhì)子磁共振波譜（proton magneticresonance spectroscopy，1H-MRS）檢查，探討經(jīng)AD8、Cog12篩查的v-MCI患者1H-MRS特點。 研究方法 第一部分： 以2012年2月至2014年2月因腦血管病或腦血管病危險因素在中國人民解放軍第八十八醫(yī)院神經(jīng)內(nèi)科門診就診或住院的患者為研究對象。研究對象分為三組：正常對照（normal control，NC）組、VD對照組和v-MCI組。對所有研究對象進行AD8、Cog12等一系列神經(jīng)心理學(xué)量表的檢測，分析比較不同組間量表評分，研究量表的敏感度和特異度。 第二部分： 對第一部分中年齡大于50歲的v-MCI患者和NC組患者進行顱腦核磁共振（magnetic resonance imagine，MRI）平掃，剔除有大面積腦梗死、關(guān)鍵部位腦梗死（如額葉、丘腦、海馬等）以及彌漫性腦白質(zhì)病變者，對符合條件者進行1H-MRS檢查，取雙側(cè)的額葉、顳葉、丘腦和海馬為感興趣區(qū)（region of interest，ROI），以N-乙酰天冬氨酸（N-acetylaspartate, NAA）、膽堿復(fù)合物（choline, Cho）、肌酸復(fù)合物（creatine, Cr）為觀察指標(biāo)，計算上述部位NAA/Cr、Cho/Cr值，分析兩組間及組內(nèi)左右兩側(cè)不同部位NAA/Cr、Cho/Cr值的變化，探討波譜早期檢測v-MCI的價值。并將符合條件的v-MCI患者分為AD8評分正常者和AD8評分增高者兩組，比較兩組間代謝物水平的差異。 研究結(jié)果 第一部分： 1.NC組、VD對照組和v-MCI組患者在年齡、性別、受教育年限方面無明顯差異（P0.05）。 2.v-MCI組與NC組、VD對照組相比，高血壓和腦血管病史的比率高于NC組，，低于VD對照組（χ2檢驗，P0.05）；心臟病、糖尿病、高脂血癥及吸煙、飲酒史的比率與NC組、VD對照組相比無明顯差異（χ2檢驗，P0.05）。 3.v-MCI組MMSE、Moca評分明顯高于VD對照組，而明顯低于NC組（P0.01）；AD8、Cog12評分明顯高于NC組而明顯低于VD對照組，差異有統(tǒng)計學(xué)意義（P0.01）。 4.在區(qū)別認知正�；颊吆蛌-MCI患者方面： （1）MMSE與Moca相比無明顯差異（P0.05），AD8與Cog12相比無明顯差異（P0.05），而MMSE和Moca與AD8和Cog12相比，AD8和Cog12優(yōu)于MMSE和Moca，差異顯著（P0.05）。 （2）當(dāng)MMSE取26.5為截斷值（cut-off）時，其敏感度和特異度略低于Moca取23.5為截斷值時的敏感度和特異度，但總體水平相當(dāng)；當(dāng)AD8和Cog12均取1.5為臨界值時，其敏感度和特異度相當(dāng)，但均高于MMSE取26.5、Moca取23.5為截斷值時的敏感度和特異度。 5.在識別VD患者與v-MCI患者方面，MMSE、Moca、AD8和Cog12均具有較高的準(zhǔn)確性，差異無統(tǒng)計學(xué)意義（P0.05）。 6.三組患者在各認知域評分方面，v-MCI組評分除Stroop色詞測驗C部分錯誤反應(yīng)得分與計時高于NC組（P0.05），而低于VD對照組外，其余各項評分明顯低于NC組（P0.05），高于VD對照組（P0.05）。v-MCI組和VD組延時記憶較瞬時記憶評分有所增加（P0.05）。 第二部分： 1.v-MCI組患者雙側(cè)額葉、顳葉、海馬、丘腦的NAA/Cr值均低于NC組，差異顯著（P0.05）。各部位的Cho/Cr值在v-MCI組和NC組之間差異無統(tǒng)計學(xué)意義（P0.05）。 2.v-MCI組左側(cè)額葉、顳葉、海馬、丘腦的NAA/Cr值均低于對側(cè)比值，差異有統(tǒng)計學(xué)意義（P0.05），而雙側(cè)的Cho/Cr值無明顯差異。（P0.05）。 3.v-MCI患者中AD8評分增高者與AD8評分正常者比較，左側(cè)4個部位NAA/Cr代謝物水平降低，差異有統(tǒng)計學(xué)意義（P0.001），右側(cè)4個部位NAA/Cr值無明顯差異（P0.05）。 研究結(jié)論 第一部分： 在區(qū)別v-MCI患者方面，與MMSE、Moca相比，AD8、Cog12具有較好的效度。在識別VD方面，MMSE、Moca、AD8和Cog12均具有較高的效度。AD8、Cog12篩查有助于早期發(fā)現(xiàn)v-MCI。 第二部分： 經(jīng)AD8、Cog12篩查的v-MCI患者在MRS觀察到額葉、顳葉、丘腦、海馬代謝異常，以左側(cè)為著。 研究意義 本研究詳細分析了AD8、Cog12量表早期檢測v-MCI認知功能的價值和1H-MRS特點，證實了AD8、Cog12量表在識別v-MCI方面的敏感性，從而為v-MCI的早期篩查提供了新方法。
[Abstract]:research objective
1. the application value of AD8 (Alzheimer disease8) and Cog12 (Alzheimer disease8) was explored through a series of neuropsychological tests for patients with cognitive normal vascular dementia (VD) and vascular mild cognitive impairment (v-MCI).
2. by conducting proton magnetic resonance spectroscopy (proton magneticresonance spectroscopy, 1H-MRS) examination of v-MCI patients and cognitive normal patients, the 1H-MRS characteristics of v-MCI patients screened by AD8 and Cog12 were investigated.
research method
Part one:
The subjects were divided into three groups: normal control (normal control, NC) group, VD control group and v-MCI group, and AD8, Cog12, etc. for all the subjects were studied in the Department of Neurology of No.88 Hospital of PLA for the risk factors of cerebrovascular disease or cerebrovascular disease from February 2012 to February 2014. A series of neuropsychological scale tests were conducted to analyze and compare the scores of different interval scales, and to study the sensitivity and specificity of the scale.
The second part:
Craniocerebral magnetic resonance (magnetic resonance imagine, MRI) scan was performed in the first part of the v-MCI patients and NC groups aged more than 50 years old, and the patients with large area cerebral infarction and cerebral infarction (such as frontal, thalamus, hippocampus, etc.) and diffuse white matter lesions were eliminated. The 1H-MRS examination was performed to the eligible subjects, and bilateral frontal and temporal lobes were taken. The thalamus and hippocampus are region of interest (ROI), with N- acetyl aspartic acid (N-acetylaspartate, NAA), choline complex (choline, Cho), and creatine complex (creatine, Cr) as the observation index. The value of v-MCI was detected early in the spectrum, and the eligible v-MCI patients were divided into two groups with normal AD8 score and higher AD8 score, and the difference of metabolites level between the two groups was compared.
Research results
Part one:
1.NC group, VD control group and v-MCI group had no significant difference in age, sex and education years (P0.05).
Compared with group NC and group VD, the ratio of hypertension and cerebrovascular history was higher than that of the group NC, which was lower than that of the VD control group (x 2 test, P0.05); the rate of heart disease, diabetes, hyperlipidemia and smoking, and the rate of drinking history were not significantly different from that of the NC group and VD control group (x 2 test, P0.05).
3.v-MCI group MMSE, Moca score was significantly higher than the VD control group, but significantly lower than the NC group (P0.01), AD8, Cog12 score was significantly higher than the NC group, and significantly lower than the VD control group, the difference was statistically significant (P0.01).
4. in distinguishing between normal cognitive patients and v-MCI patients:
(1) there is no significant difference between MMSE and Moca (P0.05), and there is no significant difference between AD8 and Cog12 (P0.05), while MMSE and Moca are better than AD8 and Cog12.
(2) when MMSE takes 26.5 as a truncated value (cut-off), its sensitivity and specificity are slightly lower than the sensitivity and specificity of Moca taking 23.5 as a truncated value, but the overall level is equal. When both AD8 and Cog12 take 1.5 as the critical value, their sensitivity and specificity are equivalent, but both are higher than MMSE and 26.5, and Moca takes 23.5 as a truncated value.
5. MMSE, Moca, AD8 and Cog12 had higher accuracy in identifying VD patients and V-MCI patients, and there was no significant difference (P 0.05).
6. in the cognitive domain score of the three groups, group v-MCI score was higher than that of group NC (P0.05), except the Stroop color word test C, and the other scores were lower than that of the NC group (P0.05), which was higher than that in the VD control group (P0.05).V-MCI group and the VD group.
The second part:
The NAA/Cr values of frontal lobes, temporal lobes, hippocampus and thalamus in group 1.v-MCI were lower than those in group NC (P0.05). There was no significant difference in the Cho/Cr value of each part between the v-MCI group and the NC group (P0.05).
The NAA/Cr values of the left frontal lobe, the temporal lobe, the hippocampus and the thalamus in the 2.v-MCI group were all lower than the contralateral ratio (P0.05), but there was no significant difference in the bilateral Cho/Cr values (P0.05).
The levels of NAA/Cr metabolites in the 4 parts of the left side of the 3.v-MCI patients were lower than those in the normal AD8 scores. The difference was statistically significant (P0.001), and there was no significant difference in the NAA/Cr value between the 4 parts of the right side (P0.05).
research conclusion
Part one:
Compared with MMSE, Moca, AD8, Cog12 has better validity in distinguishing v-MCI patients. MMSE, Moca, AD8 and Cog12 have higher validity.AD8 in the identification of VD. Cog12 screening helps to identify the early stages.
The second part:
In v-MCI patients screened by AD8 and Cog12, abnormal metabolism in frontal lobe, temporal lobe, thalamus and hippocampus was observed in MRS, with left side as the center.
research meaning
This study analyzed the value and 1H-MRS characteristics of the early detection of v-MCI cognitive function in the AD8 and Cog12 scale, and confirmed the sensitivity of the AD8 and Cog12 scale in identifying v-MCI, thus providing a new method for the early screening of v-MCI.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R749.1
本文編號：2166883
[Abstract]:research objective
1. the application value of AD8 (Alzheimer disease8) and Cog12 (Alzheimer disease8) was explored through a series of neuropsychological tests for patients with cognitive normal vascular dementia (VD) and vascular mild cognitive impairment (v-MCI).
2. by conducting proton magnetic resonance spectroscopy (proton magneticresonance spectroscopy, 1H-MRS) examination of v-MCI patients and cognitive normal patients, the 1H-MRS characteristics of v-MCI patients screened by AD8 and Cog12 were investigated.
research method
Part one:
The subjects were divided into three groups: normal control (normal control, NC) group, VD control group and v-MCI group, and AD8, Cog12, etc. for all the subjects were studied in the Department of Neurology of No.88 Hospital of PLA for the risk factors of cerebrovascular disease or cerebrovascular disease from February 2012 to February 2014. A series of neuropsychological scale tests were conducted to analyze and compare the scores of different interval scales, and to study the sensitivity and specificity of the scale.
The second part:
Craniocerebral magnetic resonance (magnetic resonance imagine, MRI) scan was performed in the first part of the v-MCI patients and NC groups aged more than 50 years old, and the patients with large area cerebral infarction and cerebral infarction (such as frontal, thalamus, hippocampus, etc.) and diffuse white matter lesions were eliminated. The 1H-MRS examination was performed to the eligible subjects, and bilateral frontal and temporal lobes were taken. The thalamus and hippocampus are region of interest (ROI), with N- acetyl aspartic acid (N-acetylaspartate, NAA), choline complex (choline, Cho), and creatine complex (creatine, Cr) as the observation index. The value of v-MCI was detected early in the spectrum, and the eligible v-MCI patients were divided into two groups with normal AD8 score and higher AD8 score, and the difference of metabolites level between the two groups was compared.
Research results
Part one:
1.NC group, VD control group and v-MCI group had no significant difference in age, sex and education years (P0.05).
Compared with group NC and group VD, the ratio of hypertension and cerebrovascular history was higher than that of the group NC, which was lower than that of the VD control group (x 2 test, P0.05); the rate of heart disease, diabetes, hyperlipidemia and smoking, and the rate of drinking history were not significantly different from that of the NC group and VD control group (x 2 test, P0.05).
3.v-MCI group MMSE, Moca score was significantly higher than the VD control group, but significantly lower than the NC group (P0.01), AD8, Cog12 score was significantly higher than the NC group, and significantly lower than the VD control group, the difference was statistically significant (P0.01).
4. in distinguishing between normal cognitive patients and v-MCI patients:
(1) there is no significant difference between MMSE and Moca (P0.05), and there is no significant difference between AD8 and Cog12 (P0.05), while MMSE and Moca are better than AD8 and Cog12.
(2) when MMSE takes 26.5 as a truncated value (cut-off), its sensitivity and specificity are slightly lower than the sensitivity and specificity of Moca taking 23.5 as a truncated value, but the overall level is equal. When both AD8 and Cog12 take 1.5 as the critical value, their sensitivity and specificity are equivalent, but both are higher than MMSE and 26.5, and Moca takes 23.5 as a truncated value.
5. MMSE, Moca, AD8 and Cog12 had higher accuracy in identifying VD patients and V-MCI patients, and there was no significant difference (P 0.05).
6. in the cognitive domain score of the three groups, group v-MCI score was higher than that of group NC (P0.05), except the Stroop color word test C, and the other scores were lower than that of the NC group (P0.05), which was higher than that in the VD control group (P0.05).V-MCI group and the VD group.
The second part:
The NAA/Cr values of frontal lobes, temporal lobes, hippocampus and thalamus in group 1.v-MCI were lower than those in group NC (P0.05). There was no significant difference in the Cho/Cr value of each part between the v-MCI group and the NC group (P0.05).
The NAA/Cr values of the left frontal lobe, the temporal lobe, the hippocampus and the thalamus in the 2.v-MCI group were all lower than the contralateral ratio (P0.05), but there was no significant difference in the bilateral Cho/Cr values (P0.05).
The levels of NAA/Cr metabolites in the 4 parts of the left side of the 3.v-MCI patients were lower than those in the normal AD8 scores. The difference was statistically significant (P0.001), and there was no significant difference in the NAA/Cr value between the 4 parts of the right side (P0.05).
research conclusion
Part one:
Compared with MMSE, Moca, AD8, Cog12 has better validity in distinguishing v-MCI patients. MMSE, Moca, AD8 and Cog12 have higher validity.AD8 in the identification of VD. Cog12 screening helps to identify the early stages.
The second part:
In v-MCI patients screened by AD8 and Cog12, abnormal metabolism in frontal lobe, temporal lobe, thalamus and hippocampus was observed in MRS, with left side as the center.
research meaning
This study analyzed the value and 1H-MRS characteristics of the early detection of v-MCI cognitive function in the AD8 and Cog12 scale, and confirmed the sensitivity of the AD8 and Cog12 scale in identifying v-MCI, thus providing a new method for the early screening of v-MCI.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R749.1
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本文編號：2166883
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