不同脑白质损伤部位对老年轻度认知障碍的影响

doi:10.3969/j.issn.1673-5765.2019.09.007

摘要/Abstract

摘要：

目的探讨不同部位脑白质损伤（white matter lesion，WML）对老年轻度认知障碍（mild cognitive impairment，MCI）的影响。方法选取200例经头颅MRI检查为WML且伴MCI的老年患者为WML组，选同期健康体检者40例作为对照组。根据病变部位将WML患者分为脑室旁组（n =64）、脑室下组（n =56）、皮层下组（n =46）和深部组（n =34）。采用蒙特利尔认知功能量表（Montreal cognitive assessment，MoCA）、简易智能量表（mini-mental state examination，MMSE）评价所有受试者的认知功能。结果 WM L组和对照组的MMSE评分分别为23.04±1.42分和28.23±1.57分，MoCA总分分别为 19.91±1.55分和25.94±2.32分，差异均有统计学意义（P分别为0.005和0.001）。在MoCA量表8个维度评分中，WML深部组的视空间/执行评分最低，皮层下组的命名及抽象思维评分最低，脑室旁组的计算和延迟回忆评分最低，脑室下组的注意力评分最低。皮层下组8个维度的分值均低于对照组，差异有统计学意义，认知领域受累范围最广泛。结论不同部位WML对老年患者认知功能及认知域的影响不同，皮层下组认知损害范围最广。

文章导读： 本研究对脑室旁、脑室下、皮层下和白质深部WML患者的认知障碍特点进行了分析，发现不同部位WML对认知功能不同维度的影响各有特点。

关键词: 脑白质损伤; 老年; 认知功能障碍

Abstract:

Objective To investigate the influence of different location of white matter lesion (WML) on mild cognitive impairment (MCI) in senile patients. Methods A total of 200 elderly patients with WML and MCI were enrolled in WML group, and 40 healthy physical examination adults were selected as control group. WML patients were divided into paraventricular subgroup (n =64), subventricular subgroup (n =56), subcortical subgroup (n =46) and deep subgroup (n =34) according to the lesion location. The cognitive function of all subjects were evaluated using the Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE). Results The MMSE scores of WML and control group were 23.04±1.42 and 28.23±1.57, respectively (P =0.005). The MoCA scores of WML and control group were 19.91±1.55 and 25.94±2.32, respectively (P =0.001). Among the 8 items of MoCA, the visual / executive scores of deep subgroup were the lowest, the naming and abstract thinking scores of subcortical group were the lowest, the calculation score and delayed recall score of paraventricular subgroup were the lowest, and the attention score of subventricular subgroup was the lowest. The scores of the 8 items in subcortical subgroup were all lower than that in control group, the differences were all statistically significant, and the involved cognitive domains were most extensive. Conclusions Different location of WML in the elderly patients had different influence on the cognitive domains, and the involved cognitive domains in patients with subcortical WML were most extensive.

Key words: Cerebral white matter lesion; Elderly; Cognitive dysfunction

胡瑞红, 柴长风, 范存秀, 毕晓莹. 不同脑白质损伤部位对老年轻度认知障碍的影响[J]. 中国卒中杂志, 2019, 14(09): 889-894.

HU Rui-Hong, CHAI Chang-Feng, FAN Cun-Xiu, BI Xiao-Ying. Influence of Different Location of White Matter Lesion on Mild Cognitive Impairment in Senile Patients[J]. Chinese Journal of Stroke, 2019, 14(09): 889-894.

参考文献

[1] SACCO R，BISECCO A，CORBO D，et al.

Cognitive impairment and memory disorders in

relapsing-remitting multiple sclerosis：the role of

white matter，gray matter and hippocampus[J]. J

Neurol，2015，262（7）：1691-1697.

[2] FERNÁNDEZ-ANDÚJAR M，SORIANO-RAYA

J J，MIRALBELL J，et al. Thalamic diffusion

differences related to cognitive function in white

matter lesions[J]. Neurobiol Aging，2014，35（5）：

1103-1110.

[3] OHLHAUSER L，PARKER A F，SMART C M，et

al. White matter and its relationship with cognition

in subjective cognitive decline[J/OL]. Alzheimers

Dement，2019，11：28-35. https：//doi.org/ 10.1016/

j.dadm.2018.10.008.

[4] GRANDE G，VANACORE N，MAGGIORE L，et al.

Physical activity reduces the risk of dementia in mild

cognitive impairment subjects：a cohort study[J]. J

Alzheimers Dis，2014，39（4）：833-839.

[5] KRELL-ROESCH J，FEDER N T，ROBERTS R O，

et al. Leisure-time physical activity and the risk of

incident dementia：the mayo clinic study of aging[J].

J Alzheimers Dis，2018，63（1）：1-7.

[6] PETERSEN R C. Mild cognitive impairment as a diagnostic entity[J]. J Intern Med，2004，256（3）：

183-194.

[7] FOSSATI C，DEBENEDETTO G，BELLOMO A，

et al. A self-administered questionnaire to screen the

risk of dementia：a pilot study and the results of a

comparison with the mini-mental state examination

（MMSE）[J]. Arch Gerontol Geriatr，2013，56（1）：

27-31.

[8] WONG G K，NGAI K，LAM S W，et al. Validity

of the Montreal Cognitive Assessment for

traumatic brain injury patients with intracranial

haemorrhage[J]. Brain Inj，2013，27（4）：394-398.

[9] MACKIN R S，INSEL P，TOSUN D，et al. The

effect of subsyndromal symptoms of depression and

white matter lesions on disability for individuals

with mild cognitive impairment[J]. Am J Geriatr

Psychiatry，2013，21（9）：906-914.

[10] DING X，WU J，ZHOU Z，et al. Specific locations

within the white matter and cortex are involved

in the cognitive impairments associated with

periventricular white matter lesions（PWMLs）[J].

Behav Brain Res，2015，128（9）：9-18.

[11] HULST H E，STEENWIJK M D，VERSTEEG A，

et al. Cognitive impairment in MS：impact of white

matter integrity，gray matter volume，and lesions[J].

Neurology，2013，80（11）：1025-1032.

[12] KIM K W，MACFALL J R，PAYNE M E.

Classification of white matter lesions on magnetic

resonance imaging in elderly persons[J]. Biol

Psychiatry，2008，64（4）：273-280.

[13] 贾晓彧，张爱娟，王琦，等. 不同部位缺血性脑白质

病变对患者不同认知领域的影响[J]. 中华老年医学

杂志，2012，31（3）：211-214.

[14] SORIANO-RAYA J J，MIRALBELL J，LÓPEZCANCIO

E，et al. Deep versus periventricular

white matter lesions and cognitive function in a

community sample of middle-aged participants[J]. J

Int Neuropsychol Soc，2012，18（5）：874-885.

[15] TASCHNER C A，BRENDECKE S，TRIPPEL

M，et al. Freiburg neuropathology case conference：

contrast-enhancing white matter lesion adjacent

to the lateral ventricle[J]. Clinical Neuroradiology，

2013，23（2）：165-167.

[16] PAVLOVA M A，KRÄGELOH-MANN I.

Limitations on the developing preterm brain：impact

of periventricular white matter lesions on brain

connectivity and cognition[J]. Brain，2013，136（4）：

998-1011.

[17] BESTER M，LAZAR M，PETRACCA M，et al.

Tract-specific white matter correlates of fatigue and

cognitive impairment in benign multiple sclerosis[J].

J Neurol Sci，2013，330（1-2）：61-66.

[18] SORIANORAYA J J，MIRALBELL J，

LÓPEZCANCIO E，et al. Deep versus periventricular

white matter lesions and cognitive function in a

community sample of middle-aged participants[J]. J

Int Neuropsychol Soc，2012，18（5）：874-875.

[19] MÜHLAU M，BUCK D，FÖRSCHLER A，et al.

White-matter lesions drive deep gray-matter atrophy

in early multiple sclerosis：support from structural

MRI[J]. Mult Scler，2013，19（11）：1485-1492.

[20] KUCEYESKI A，MONOHAN E，MORRIS E，et

al. Baseline biomarkers of connectome disruption

and atrophy predict future processing speed in early

multiple sclerosis[J/OL]. Neuroimage Clin，2018，19：

417-424. https：//doi.org/10.1016/j.nicl.2018.05.003.

[21] KURIYAMA N，MIZUNO T，OHSHIMA Y，et al.

Intracranial deep white matter lesions（DWLs）are

associated with chronic kidney disease（CKD）and

cognitive impairment：a 5-year follow-up magnetic

resonance imaging（MRI）study[J]. Arch Gerontol

Geriatr，2013，56（1）：55-60.

[22] THONG J Y，DU J，RATNARAJAH N，et al.

Abnormalities of cortical thickness，subcortical

shapes，and white matter integrity in subcortical

vascular cognitive impairment[J]. Hum Brain Mapp，

2014，35（5）：2320-2332.

[23] LIU X，CHENG R，CHEN L，et al. Alterations

of white matter integrity in subcortical ischemic

vascular disease with and without cognitive

impairment：a TBSS study[J]. J Mol Neurosci，2019，

67（4）：595-603. .

[24] YE Q，BAI F. Contribution of diffusion，perfusion

and functional MRI to the disconnection hypothesis

in subcortical vascular cognitive impairment[J].

Stroke Vasc Neurol，2018，3（3）：131-139.

[25] SHINDO A，LIANG A C，MAKI T，et al.

Subcortical ischemic vascular disease：roles of

oligodendrocyte function in experimental models

of subcortical white-matter injury[J]. J Cereb Blood

Flow Metab，2016，36（1）：187-198.

[26] BLASI F，WEI Y，BALKAYA M，et al. Recognition

memory impairments after subcortical white matter

stroke in mice[J]. Stroke，2014，45（5）：1468-1473.