本文選題：白質(zhì)疏松 + 血管性認(rèn)知功能障礙�。� 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：【研究背景】腦白質(zhì)疏松(leukoaraiosis，LA)是一類(lèi)常見(jiàn)于中老年人的白質(zhì)病變，可能會(huì)引起認(rèn)知功能障礙、步態(tài)異常和尿便失禁等癥狀。LA的病因未完全明確，但越來(lái)越多的研究提示LA是一種皮質(zhì)下小血管病變，LA相關(guān)的認(rèn)知下降被認(rèn)為是血管性認(rèn)知功能障礙（vascular cognitive impairment，VCI）的一個(gè)亞型。VCI表現(xiàn)形式多樣，目前尚缺乏公認(rèn)的神經(jīng)心理學(xué)檢查，這是導(dǎo)致既往LA認(rèn)知功能方面研究結(jié)果不一致的重要原因之一。2006年美國(guó)國(guó)立神經(jīng)疾病卒中研究所和加拿大卒中網(wǎng)（National Institute of Neurological Disorders andStroke-Canadian，NINDS-CSN）篩選制定了一套60分鐘方案神經(jīng)心理檢查專(zhuān)門(mén)用于VCI的研究，國(guó)內(nèi)尚未見(jiàn)應(yīng)用全套60分鐘方案檢查于LA的研究。另外，對(duì)于LA病變程度的評(píng)估，國(guó)內(nèi)均使用視覺(jué)定性的評(píng)估方法，，未見(jiàn)通過(guò)測(cè)定LA體積來(lái)研究其與認(rèn)知功能的報(bào)道。 【目的】采用60分鐘方案神經(jīng)心理檢查法，研究LA患者的認(rèn)知功能特點(diǎn)；嘗試定量測(cè)算LA體積，分析其與定性評(píng)分法和LA認(rèn)知功能的相關(guān)性。 【方法】對(duì)LA病例組60例（根據(jù)Fazekas評(píng)分標(biāo)準(zhǔn)分為輕度、中度、重度三組）及健康對(duì)照組29例，應(yīng)用美國(guó)國(guó)立神經(jīng)疾病卒中研究所和加拿大卒中網(wǎng)（NINDS-CSN）推薦的60分鐘方案神經(jīng)心理量表進(jìn)行記憶力、執(zhí)行功能、注意力、語(yǔ)言功能和視空間五個(gè)認(rèn)知領(lǐng)域的檢查，分析白質(zhì)疏松患者認(rèn)知功能損害的特點(diǎn)；應(yīng)用圖像軟件Image-pro Plus（IPP）測(cè)算LA的體積，分析體積定量測(cè)定與Fazekas定性評(píng)分的相關(guān)性。 【結(jié)果】 1、與對(duì)照組比較：1）輕度病例組分別在連線測(cè)驗(yàn)B部分（trail making testB,TMTB）得分、Stroop色詞測(cè)驗(yàn)C部分（Stroop color word test C,SCWTC）錯(cuò)誤數(shù)得分、符號(hào)數(shù)字轉(zhuǎn)換測(cè)驗(yàn)（symbol digit modalities test,SDMT）得分、連線測(cè)驗(yàn)A部分（trail making test B,TMTA）得分、詞語(yǔ)流暢性測(cè)驗(yàn)（verbal fluencytest,VFT）15秒動(dòng)物數(shù)得分，兩者間的差異有統(tǒng)計(jì)學(xué)意義；2）中度病例組分別在簡(jiǎn)易精神狀態(tài)檢查量表（Mini-mental state examination,MMSE）得分、聽(tīng)覺(jué)詞語(yǔ)學(xué)習(xí)測(cè)驗(yàn)（auditory verbal learning test,AVLT）的即刻回憶、短延時(shí)回憶、長(zhǎng)延時(shí)回憶及再認(rèn)得分、VFT15秒動(dòng)物數(shù)、45秒動(dòng)物數(shù)及1分鐘動(dòng)物數(shù)、SDMT得分、TMTA得分、TMTB得分、SCWTC的耗時(shí)數(shù)和錯(cuò)誤數(shù)得分，兩者間的差異有統(tǒng)計(jì)學(xué)意義；3）重度病例組分別在MMSE得分、AVLT即刻回憶、短延時(shí)回憶、長(zhǎng)延時(shí)回憶及再認(rèn)得分、VFT15秒動(dòng)物數(shù)、45秒動(dòng)物數(shù)及1分鐘動(dòng)物數(shù)、波士頓命名（Boston naming test,BNT）得分、畫(huà)鐘測(cè)驗(yàn)(clock drawing test,CDT)得分、SDMT得分、TMTA得分、TMTB得分、SCWTC的耗時(shí)數(shù)得分和錯(cuò)誤數(shù)得分，兩者間的差異有統(tǒng)計(jì)學(xué)意義。 2、病例組之間比較：1）輕度與中度：除AVLT再認(rèn)得分、TMTB得分和SCWTC錯(cuò)誤數(shù)得分兩者間差異無(wú)統(tǒng)計(jì)學(xué)意義外，其余測(cè)驗(yàn)得分的差異均有統(tǒng)計(jì)學(xué)意義。2）輕度與重度：除SCWTC錯(cuò)誤數(shù)得分兩者間差異無(wú)統(tǒng)計(jì)學(xué)意義外，其余測(cè)驗(yàn)得分的差異均有統(tǒng)計(jì)學(xué)意義。3）中度與重度：兩組間只有TMTB得分的差異有統(tǒng)計(jì)學(xué)意義，其余測(cè)驗(yàn)得分的差異均無(wú)統(tǒng)計(jì)學(xué)意義。 3、使用Image-pro Plus測(cè)算的體積與Fazekas定性評(píng)分顯著正相關(guān),spearman相關(guān)系數(shù)r=0.828，具有統(tǒng)計(jì)學(xué)意義。 4、LA體積與MMSE、AVLT即刻回憶、AVLT短延遲回憶、AVLT長(zhǎng)延遲回憶、AVLT再認(rèn)、CDT、AFT45秒動(dòng)物數(shù)、AFT1分鐘動(dòng)物數(shù)呈負(fù)相關(guān)，spearman相關(guān)系數(shù)r=-0.445～-0.258，具有統(tǒng)計(jì)學(xué)意義；LA體積與TMTB得分和SCWTC耗時(shí)得分呈正相關(guān)，spearman相關(guān)系數(shù)r分別為0.523、0.564，具有統(tǒng)計(jì)學(xué)意義。 【結(jié)論】 1、輕度LA患者存在執(zhí)行功能和注意力損傷，中度和重度LA患者存在語(yǔ)言功能、記憶力、執(zhí)行功能和注意力損傷，LA患者視空間功能相對(duì)保留完整。LA中度病變期，注意力和執(zhí)行功能障礙顯著進(jìn)展，并出現(xiàn)記憶力和語(yǔ)言功能的損傷；LA重度病變期，執(zhí)行功能障礙顯著進(jìn)展，記憶力、語(yǔ)言功能和注意力的下降相對(duì)平穩(wěn)。 2、可使用Image-pro Plus軟件測(cè)算LA的體積。LA患者的總體認(rèn)知功能、記憶力和執(zhí)行功能隨LA體積增長(zhǎng)而下降。
[Abstract]:[background] leukoaraiosis (LA) is a kind of white matter common in middle-aged and elderly people, which may cause cognitive dysfunction, gait abnormalities and urinary incontinence and other symptoms of.LA are not completely clear, but more and more studies suggest that LA is a subcortical small vascular disease, and the cognitive decline associated with LA is considered to be blood. A subtype of vascular cognitive impairment (VCI) has a variety of.VCI manifestations, and there is still a lack of recognized neuropsychological examination. This is one of the important reasons for the inconsistent results of previous LA cognitive functions, one of the national national neurodiseases stroke Institute and the Canadian Stroke Network (Nationa),.2006. L Institute of Neurological Disorders andStroke-Canadian, NINDS-CSN) screening and formulating a set of 60 minute program neuropsychological examination specially used for the study of VCI. There has not been a complete set of 60 minutes for the study of LA. In addition, the assessment of the degree of LA lesions, the use of visual qualitative assessment methods, has not been passed. LA volume was measured to study its cognitive function.
[Objective] to study the cognitive function of LA patients by 60 minute scheme neuropsychological examination, and to try to measure the volume of LA quantificationally and analyze the correlation between the qualitative score and the cognitive function of LA.
[Methods] 60 cases of LA case group (divided into mild, moderate, severe, three groups according to the Fazekas score) and the healthy control group were 29 cases. The memorizing force, executive function, attention, language function and visual space were performed by the national neurologic stroke research institute and the Canadian Stroke Network (NINDS-CSN) recommended by the Canadian Stroke Network (NINDS-CSN). A cognitive field was examined to analyze the characteristics of cognitive impairment in patients with leukoaraiosis. The volume of LA was measured by Image-pro Plus (IPP), and the correlation between volume quantitative determination and Fazekas qualitative score was analyzed.
[results]
1, compared with the control group: 1) the mild case group was scored in the B part (trail making testB, TMTB), the C part of the Stroop color word test (Stroop color word test C), the score of the symbol digital conversion test, the score of the connection test, and the words and expressions. The scores of verbal fluencytest (VFT) 15 seconds were statistically significant; 2) the moderate case group was scored in the simple mental state Checklist (Mini-mental state examination, MMSE), the immediate recollection of the auditory word learning test (auditory verbal learning test, AVLT), the short delay memory, the long delay. Memory and recognition scores, VFT15 seconds animals, 45 seconds of animals and 1 minutes of animals, SDMT scores, TMTA scores, TMTB scores, SCWTC time and error scores, the difference between the two is statistically significant; 3) severe case group in MMSE score, AVLT immediate memory, short delay memory, long delay recall and recognition score, VFT15 second animals The number, the 45 second animal number and the 1 minute animal number, the Boston naming test (BNT) score, the clock test (clock drawing test, CDT) score, the SDMT score, the TMTA score, the TMTB score, the time score and the error number of the SCWTC, the difference between the two has the significance of unified planning.
2, compared with the case group: 1) mild and moderate: except AVLT recognition score, TMTB score and SCWTC error score had no statistical significance, the difference of the other scores were statistically significant.2) mild and severe: except for the difference between the SCWTC error scores, there were differences in the scores of the other tests. Statistical significance.3) moderate and severe: there was statistical difference in the TMTB scores between the two groups, but there was no statistically significant difference in the other test scores.
3, the volume calculated by Image-pro Plus was positively correlated with the qualitative score of Fazekas, and the Spearman correlation coefficient r=0.828 was statistically significant.
4, LA volume and MMSE, AVLT immediate recollection, AVLT short delay memory, AVLT long delayed recall, AVLT recognition, CDT, AFT45 second animal number, AFT1 minute animal number is negative correlation, Spearman correlation coefficient r=-0.445 ~ -0.258, has statistical significance. It has statistical significance.
[Conclusion]
1, patients with mild LA had executive function and attention impairment. Moderate to severe LA patients had language function, memory, executive function, and attention impairment. The visual space function of LA patients retained complete.LA moderate pathological changes, attention and executive dysfunction were significantly progressed, and memory and language function was damaged; LA severe lesions were found. During the period, executive dysfunction progressed significantly, and memory, language function and attentional decline were relatively stable.
2, we can use Image-pro Plus software to measure the volume of LA, the overall cognitive function of.LA patients, and the memory and executive function decrease with the increase of LA volume.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 何國(guó)軍,陳俊拋,溫志波,楊波;阿爾茨海默病與血管性癡呆胼胝體的體視學(xué)定量研究[J];中國(guó)臨床康復(fù);2004年10期

本文編號(hào)：2032228