皮质下脑梗死所致血管性认知障碍患者认知功能与脑白质病变的相关性研究

目的 分析皮层下脑梗死所致血管性认知障碍 （subcorticalvascular cognitive impairment， SVCI） 脑白质 变性与认知功能评分的相关性。 方法 连续入组皮层下脑梗死患者91例， 根据神经心理学蒙特利尔认知评估 （Montreal Cognitive Assessment， MOCA） 分为皮层下脑梗死所致血管性认知障碍 （subcortical vascular cognitive impairment， SVCI） 组 （49例） 和无认知障碍的皮质下梗死 （subcortical infarcts， SI） 组 （42例） ， 分析其临床、 认知 障碍、 神经影像学特征， 并探讨认知障碍与白质损伤的相关性。 结果 SVCI组糖尿病发病率高于SI组 （38.78% vs 16.67%， P =0.02） ， SVCI组脑白质病变患者37 例 （75.51%） 。 脑白质损害程度与MOCA执行功能 （ Rs =-0.415， P =0.028） 、 瞬时记忆 （ Rs =-0.577， P =0.001） 、 注意 （ Rs =-0.382， P =0.001） 、 延迟记忆 （ Rs =-0.389， P =0.041） 等4个分量表以及MOCA 量表总分 （ Rs =-0.495， P =0.002） 成负相关。 结论 SVCI患者糖尿病比例高于SI患者， 白质病变多见， 且白质病变的程度可以反映不同程度的认知 损害。

Association between White Matter Changes and Cognitive Impairment in Patients with Subcortical Vascular Cognitive Impairment

Objective To investigate the association between white matter changes of subcortical infarction vascular cognitive impairment and cognitive assess scores. Methods Ninety-one patients with subcortical infarction were consecutively recruited. According to Montreal cognitive assessment(MOCA), they were divided into two groups as subcortical vascular cognitive impairment group (SVCI, 49 cases) and subcortical infarction without cognitive impairment group (SI, 42 cases). The correlation between Cognitive impairment and white matter lesions by analysis the clinical, cognitive impairment and neuroimaging characteristics of patients were explored. Results The incidence of diabetes in SVCI patients is higher than SI patients (38.78% vs 16.67%, P =0.02). Cerebral white matter changes were found in 37 cases (75.51%) of SVCI patients. There is a negative correlation between the degree of white matter lesion and visuospatial executive( Rs = - 0.415, P =0.028), memory( Rs = - 0.577, P =0.001), attention( Rs = - 0.382, P =0.001), delay recall( Rs = - 0.389, P =0.041) according to MOCA assessment ( Rs = - 0.495, P =0.002). Conclusion Diabetes is an important risk factor in SVCI patients. White matter change is the most important imaging features, and reflects the degree of cognitive impairment.