本文選題：中年人 + 神經(jīng)心理量表　； 參考：《南方醫(yī)科大學》2014年碩士論文

【摘要】：目的： 用MoCA (Montreal Cognitive Assessment)診斷出輕度認知障礙無癡呆的中年病人,結合高場強磁共振掃描儀對發(fā)現(xiàn)腦微出血(cerebral microbleeds)者進行研究。通過年齡分組后的相關比較結果,探討神經(jīng)心理量表與SWAN聯(lián)合后對中年血管性輕度認知障礙無癡呆的診斷。 材料與方法： 通過對經(jīng)神經(jīng)心理量表——HAMD (Hamilton Depression Rating Scale for Depression)、MMSE (Mini-Mental State Examination)及MoCA評估后存在輕度認知障礙并無癡呆的神經(jīng)內(nèi)科住院病人行全腦SWAN,選出33例存在微出血的樣本組,與20例健康對照進行分組研究,其中樣本組45-52歲10例,53-59歲23例。兩組樣本年齡、受教育程度符合正態(tài)分布。所有受試對象均無其它神經(jīng)系統(tǒng)疾病史、外傷史,無糖尿病。使用GE公司的3.0T SIGNA EXITE超導型全身磁共振掃描儀,采用八通道頭部相控陣線圈。所有受檢對象接受磁共振全腦T1WI、T2WI、T2FLAIR、DWI及SWAN檢查。SWAN采用雙次激發(fā)的3D-SWAN序列,掃描時間為5分鐘。在GE公司提供的ADW4.3工作站上,利用Functool軟件對SWAN數(shù)據(jù)資料進行最小密度投影后處理。具體處理步驟如下：SWAN的原始數(shù)據(jù)是一系列連續(xù)層面的圖像對,每一對圖像包括在解剖結構上一一對應的幅值圖和相位圖。通過包括復數(shù)重組,K空間濾波取出偽影,相位蒙片和加權等步驟后,得到一系列連續(xù)的圖像層,最后從這些圖像層里得到連續(xù)的血管結構和微出血的圖像(這些病灶或靜脈血管在SWAN中多顯示為低信號),隨后用Min1P在低密度組織的三維重建上對圖像后處理,之后在獲得的最小密度投影圖上對每個研究對象的MBs (Microbleeds)位置及數(shù)量進行記錄。 用峰度(Kurtosis)分析不同組樣本的年齡差異；不同年齡組樣本間量表得分的關系選擇探索性分析(Exploratory Factor Analysis); MBs與量表之間的相關性選Pearson相關分析。以上統(tǒng)計分析通過SPSS16.0統(tǒng)計軟件包完成,P值0.05認為差異有統(tǒng)計學意義。 結果： 1.1、樣本年齡呈正態(tài)分布(年齡分布Q-Q圖),平均年齡54.26歲。 1.2、樣本年齡分布形態(tài)提示年齡位于53-59歲數(shù)量較多(k=—0.546,峰度分析)。 1.3、常規(guī)年齡差異無統(tǒng)計學意義(P=0.206,常規(guī)統(tǒng)計學評估)。 2、45-49歲組受教育程度最高(P0.05,兩樣本T檢驗)。 3.1、MMSE評價結果顯示,樣本均無癡呆及抑郁。 3.2、樣本病人組量表結果均表現(xiàn)為輕度認知障礙無癡呆,ICC值0.755(重測信度檢驗)。 3.3、所有不同年齡組間病人量表得分無差異(P=53.4444)；量表的分異常的年齡分界線為56歲(探索性分析)。 3.4、對照組一例樣本MoCA評分小于25分,考慮為神經(jīng)退行性變較重所致, 其余量表結果均屬于正常水平。 4.1.1、樣本病人組腦微出血僅位于一個腦葉內(nèi)的有：額葉2例,頂葉2例,枕葉1例,基底節(jié)3例,丘腦6例,幕下9例；大于等于兩個腦葉內(nèi)的為10例。 4.1.2、樣本出現(xiàn)腦微出血,無論位于幕上、幕下或是全腦,都會導致認知水平下降,產(chǎn)生輕度認知障礙無癡呆(r=0.13, Pearson Correlation)。 4.2、樣本病人組T2FLAIR均發(fā)現(xiàn)腦白質(zhì)變性,TlWI、T2WI及DWI無明顯其它病灶；對照組中10例發(fā)現(xiàn)腦白質(zhì)變性,其余10例影像學檢查結果無異常。結論： 1、神經(jīng)精神量表HAMD、MMSE及MoCA相結合,能診斷中年人患輕度認知障礙無癡呆,且患病年齡分界為56歲。 2、出現(xiàn)腦微出血,無論位于幕上、幕下或是全腦,都會導致患者認知水平下降,產(chǎn)生輕度認知障礙無癡呆。 因此我們認為,神經(jīng)心理量表MoCA與SWAN結合,能診斷中年病人由腦微出血導致的的血管性認知障礙無癡呆。
[Abstract]:Purpose :

In the middle - aged patients with mild cognitive impairment and no dementia by MoCA ( Montreal Assessment Assessment ) , the authors studied the patients with cerebral microbleeds combined with high field intensity magnetic resonance scanner . The diagnosis of mild cognitive impairment in middle - aged patients with mild cognitive impairment was investigated by means of correlation results after age grouping .

Materials and Methods :

All subjects received magnetic resonance all - brain T _ 1WI , T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ T _ ( T _ T ) , T _ T _ ( T _ T ) and weighted imaging .

The age difference of different group samples was analyzed by Kurtosis .
The correlation between the scores of the samples of different age groups was selected as exploratory factor analysis ; the correlation between the MBs and the scale was Pearson correlation analysis . The above statistical analysis was completed by SPSS 16.0 statistical software package , and the difference was found to be statistically significant .

Results :

1.1 . The age of the samples was normal distribution ( age distribution Q - Q ) . The mean age was 54.26 years .

1.2 . The age distribution of the samples showed that the age was in the range of 53 - 59 years ( k = - 0.546 , peak analysis ) .

1.3 General age difference was not statistically significant ( P = 0.206 , routine statistical evaluation ) .

2 . The education level of 45 - 49 years old group was the highest ( P0.05 , two sample T tests ) .

3.1 . The results of MMSE evaluation showed that none of the samples had dementia and depression .

3.2 The results of the sample patient group showed mild cognitive impairment without dementia , with an ICC value of 0.755 ( retest reliability test ) .

3.3 All patients with different age groups had no difference ( P = 53.4444 ) .
The dividing line of the sub - anomaly of the scale was 56 years old ( exploratory analysis ) .

3.4 . One sample of the control group had a MoCA score of less than 25 points , which was considered to be due to the heavy degeneration of the nerve ,

The remaining scale results were normal .

4.1 . 1 The cerebral microbleeds in the sample patients were located in only one brain lobe : frontal lobe 2 , parietal 2 , occipital lobe 1 , basal ganglia 3 , thalamus 6 , supratentorial 9 ;
more than or equal to 10 cases within the two brain lobes .

4.1 . 2 The brain microbleeds in the sample , whether located on the screen , under the screen or the whole brain , result in a decrease in cognitive level , with mild cognitive impairment no dementia ( r = 0.13 , Pearson Correlation ) .

4.2 . All patients with T2FLAIR showed no obvious other foci of brain white matter degeneration , T _ WI , T _ T _ T _ T and DWI .
In the control group , there were 10 cases of brain white matter degeneration , and the other 10 cases showed no abnormality . Conclusion :

1 . Combined with the neuropsychiatric rating scale , MMSE and MoCA , the middle - aged people were diagnosed with mild cognitive impairment without dementia , and the age of illness was 56 years .

2 . The occurrence of cerebral microbleeds , whether located on the supratentorial , supratentorial or all - brain , leads to a decrease in the cognitive level of the patient , resulting in a mild cognitive impairment of dementia .

Therefore , the neuropsychological scale MoCA combined with SWAN can diagnose vascular cognitive impairment caused by cerebral microbleeds in middle - aged patients without dementia .

【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R749.1;R743.34;R445.2

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本文編號：1731710