【摘要】：背景隨著全球老齡化進(jìn)程的加快，老年人群中認(rèn)知功能障礙的發(fā)生率逐漸增加，人們對“癡呆”投向越來越多的關(guān)注。但伴隨著研究的深入，學(xué)者們認(rèn)識到癡呆的概念存在著明顯的滯后性，輕度認(rèn)知功能障礙(mild cognitive impairment,MCI)的概念隨之運(yùn)用而生。MCI是癡呆的高危人群，發(fā)展成癡呆的危險(xiǎn)性是正常老人的10倍，部分患者是癡呆的前期階段。因此及早發(fā)現(xiàn)及干預(yù)MCI，以延緩甚至阻止癡呆的發(fā)生，具有重要的臨床意義。國內(nèi)外已有大量的研究表明腦白質(zhì)病變(white matter lesions, WML)與認(rèn)知功能障礙關(guān)系密切，甚至認(rèn)為WML本身就是認(rèn)知功能障礙的一個(gè)獨(dú)立危險(xiǎn)因素。本研究著眼于不同程度及不同部位WML對老年男性患者認(rèn)知功能的影響，探討該人群發(fā)生認(rèn)知功能障礙的危險(xiǎn)因素，為以后臨床預(yù)防工作提供理論依據(jù)。 全文共包括三部分內(nèi)容： 第一部分老年男性腦白質(zhì)病變與認(rèn)知情況篩查 目的篩查部隊(duì)老年男性高干WML與認(rèn)知情況 方法選擇2010年3月-2011年3月在我院南樓神經(jīng)內(nèi)科住院的老年男性患者179例，采集臨床資料，引入神經(jīng)心理評估量表篩查患者認(rèn)知情況。 結(jié)果WML患者114例，占總?cè)藬?shù)的63.68%，其中MCI44例，AD4例，MD20例。 結(jié)論部隊(duì)老年男性患者腦白質(zhì)病變患病率較高，尤其是80歲以上人群。 第二部分老年男性腦白質(zhì)病變患者認(rèn)知功能特點(diǎn)的研究 目的探討不同部位不同程度WML對老年男性患者認(rèn)知功能的影響 方法選取住院期間WML患者64例，視覺分析WML的不同程度，并按腦室周圍病變（PVL）分類：對照組（PVL=0）16例；輕度組（PVL=1）33例；中重度組（PVL=2或3）15例；按深部腦白質(zhì)病變（DWML）分類：對照組（DWML=0）12例；輕度組（DWML=1）39例；中重度組（DWML=2或3）13例。分析不同部位不同程度WML對認(rèn)知功能的影響。 結(jié)果不同部位及不同程度WML可造成MoCA總分及各分項(xiàng)評分隨病情加重降低趨勢，其中①PVL：中重度組MoCA總分與對照組、輕度組相比；輕、中重度組定向力得分與對照組相比；中重度組延遲回憶得分與對照組相比；輕度組注意力得分與中重度組相比差別具有統(tǒng)計(jì)學(xué)意義（P0.05）。②DWML：中重度組MoCA總分與命名得分與對照組相比差別具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論老年男性患者腦白質(zhì)病變與認(rèn)知功能減退有關(guān)，腦室旁腦白質(zhì)病變對認(rèn)知功能的影響較深部腦白質(zhì)病變明顯。 第三部分老年男性腦白質(zhì)病變患者認(rèn)知功能障礙危險(xiǎn)因素的分析 目的探討老年男性WML患者認(rèn)知功能障礙的危險(xiǎn)因素。 方法1.選取住院期間的WML患者64例，引入MoCA量表進(jìn)行認(rèn)知心理學(xué)評估，收集臨床資料，完善實(shí)驗(yàn)室及顱腦MRI等檢查。2.將患者分成輕度認(rèn)知功能障礙組（MCI組，31例）和認(rèn)知功能正常組（NC組，33例），，行單因素分析和多因素Logistic回歸分析。 結(jié)果1.單因素分析兩組在年齡、教育年限、吸煙等3方面差別具有統(tǒng)計(jì)學(xué)意義（P0.05）；2.以有無認(rèn)知功能障礙為因變量行逐步Logistic回歸分析，得到教育年限（P值0.003，OR值0.867）、吸煙（P值0.005，OR值5.151）、腔隙性腦梗死（P值0.037，OR值3.766）與腦白質(zhì)認(rèn)知功能障礙的發(fā)生有關(guān)。 結(jié)論部隊(duì)老年男性高干腦白質(zhì)病變患者認(rèn)知功能障礙主要與教育年限、腔隙性腦梗死和吸煙有關(guān)。
[Abstract]:With the acceleration of the global aging process, the incidence of cognitive dysfunction in the elderly population has increased, and more and more attention has been paid to the "dementia". But with the in-depth of the study, the scholars realized that the concept of dementia was significant, and the concept of mild cognitive impairment (MCI) was used. MCI is a high-risk group of dementia, and the risk of developing dementia is 10 times that of the normal old man, and some of the patients are the early stage of dementia. Therefore, it is of great significance to find and intervene with MCI in order to delay or prevent the occurrence of dementia. At home and abroad, a large number of studies have shown that white matter disease (WML) is closely related to cognitive dysfunction, and even that WML itself is an independent risk factor for cognitive dysfunction. This study focuses on the effect of WML on the cognitive function of the elderly male patients with different degrees and different parts, and discusses the risk factors of cognitive impairment in the population and provides a theoretical basis for future clinical prevention. The full text includes three parts Appearance: The first part of the senile male white matter lesions and the cognition Screening for screening of the situation for the purpose of screening the high-dry WM of the elderly male in the The method of L and cognition was selected from March 2010 to March 2011 in the elderly male in the Department of Neurology of the South Building of our hospital. 179 patients with sex, the clinical data was collected, and the neuropsychological evaluation scale screen was introduced. Results:114 of the patients with WML accounted for 63.68% of the total, of which,44 of them, A Conclusion The prevalence of white matter lesions in the elderly male is high. in particular of that age of 80. the second part of the elderly male is brain-white The purpose of the study of cognitive function in patients with quality disease is to study the different degrees of W in different parts. The Influence of ML on the Cognitive Function of the Elderly Male Patients and the WML in the Hospitalization Period In 64 patients, the different degrees of WML were visually analyzed and classified according to the periventricular lesion (PVL): control group (PVL = 0)16 cases, mild group (PVL = 1)33 cases, moderate to severe group (PVL = 2 or 3)15 cases, classification of deep white matter lesions (DWML): control group (DWML = 0)12 cases, mild group (DWML = 1),39 cases; 13 cases of moderate to severe group (DWML = 2 or 3). The analysis was different The effects of different parts of WML on the cognitive function were studied. Results The total score of MoCA and the score of each sub-item were decreased with the severity of the disease. The total score of MoCA in the moderate and severe group and the control group and the mild group of the MoCA in the moderate and severe group were compared with those in the control group. Compared with the control group, the directional force score of the moderate to severe group is less than that of the control group; the moderate to severe group delayed recall score is compared with the control group; the mild group attention score and the moderate to severe group The difference was statistically significant (P0.05). DWML: The total score of MoCA in moderate and severe group and the named score and control Conclusion The white matter lesions in the elderly are related to the decrease of cognitive function, and the brain of the ventricle is white. The effect of quality lesion on cognitive function is more obvious than that of deep white matter. The third part Analysis of the risk factors of cognitive impairment in senile male white matter lesions to spy on A study on the risk factors of cognitive dysfunction in elderly male WML patients. Methods 1.64 patients with WML in the hospital were selected and the MoCA scale was introduced to study the cognitive function. 2. The patients were divided into mild cognitive impairment group (MCI group,31 cases) and cognitive function normal group (NC group, 33 cases) Results 1. Single factor analysis of two groups at age, 2. The age of education (P-value 0.003, OR value 0.867), smoking (P-value 0.005, OR value 5.151) and lacunar cerebral infarction (P-value 0 .037, OR value 3.766) was related to the occurrence of white matter cognitive dysfunction.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.1

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