Comparison of Cognitive Impairment between Arteriosclerotic Cerebral Small Vessel Disease and Alzheimer's Disease

doi:10.3969/j.issn.1673-5765.2020.04.004

Abstract

Abstract:

Objective To compare the characteristics of cognitive impairment of arteriosclerotic cerebral small vessel disease (aCSVD) and Alzheimer's disease (AD). Methods The demographic data, cognitive function assessment scores (MMSE and MoCA) of aCSVD and AD patients at Department of Neurology of the Third Affiliated Hospital of Sun Yatsen University from September 2017 to May 2019 were retrospectively collected, to compare the difference of cognitive impairment characteristics and vascular risk factors between aCSVD and AD patients. Results A total of 106 patients were included in aCSVD group and 88 patients in AD group. Compared with AD group, aCSVD group had a higher percentage of hypertension (P <0.001), higher BMI (P =0.002) and lower age (P <0.001).Based on the items of MMSE, aCSVD group showed poorer performance in attention and calculation (P <0.001) and execution (P <0.001) than AD group, while AD group showed poorer performance in orientation (P <0.001), delayed recall (P <0.001), rehearsal (P =0.001), understanding (P <0.001) and writing (P =0.014) than aCSVD group. Based on the items of MoCA, aCSVD group showed lower scores in visuospatial and executive function (P <0.001), decreasing numbers (P <0.001) than AD group, while AD group showed lower scores in naming (P <0.001), digital repeat (P =0.001), language (P <0.001), abstraction (P <0.001), delayed recall (P <0.001) and orientation (P <0.001) than aCSVD group. Conclusions The age of cognition impairment onset was earlier in aCSVD patients than AD patients. For the dimension of cognitive impairment, aCSVD patients were prone to attention, calculation, visuospatial and execution deficits, while AD patients were prone to orientation, delayed recall and language impairment.

Key words: Arteriosclerotic cerebral small vessel disease; Alzheimer's disease; Cognitive impairment; Vascular risk factor

摘要：

目的比较动脉硬化性脑小血管病（arteriosclerotic cerebral small vessel disease，aCSVD）与阿尔茨海默病（Alzheimer’s disease，AD）患者认知功能损害特征。方法回顾性收集2017年9月-2019年5月中山大学附属第三医院神经内科临床诊断为aCSVD及AD患者的一般资料、认知功能评估量表（MMSE及MoCA），比较两组患者的血管危险因素及认知功能损害特征的差异。结果 aCSVD组共纳入106例，AD组88例。aCSVD组患者年龄较低、BMI较高、高血压患者比例较高，差异均具有统计学意义。MMSE量表各子项评分比较，aCSVD组的注意力与计算力、执行评分低于 AD组，AD组的定向力、延迟回忆、复述、理解及书写评分低于aCSVD组；MoCA量表各子项评分比较， aCSVD组的视空间与执行功能、数字递减评分低于AD组，AD组的命名、数字重复、语言能力、抽象能力、延迟回忆及定向力评分低于aCSVD组，差异均具有统计学意义。结论 aCSVD认知障碍发病年龄低于同等认知程度的AD组。aCSVD认知损害维度以注意力与计算力、视空间与执行功能损害为主，而AD以定向力、延迟回忆、语言能力损害为主。

关键词: 动脉硬化性脑小血管病; 阿尔茨海默病; 认知功能障碍; 血管危险因素

AI Lu-Lu, CHEN Xiao-Dong, ZHANG Bing-Jun, MEN Xue-Jiao, MA Xiao-Meng, ZHU Can-Sheng, LU Zheng-Qi. Comparison of Cognitive Impairment between Arteriosclerotic Cerebral Small Vessel Disease and Alzheimer's Disease[J]. Chinese Journal of Stroke, 2020, 15(04): 349-353.

艾璐璐，陈小东，张炳俊，门雪娇，马晓萌，朱灿胜，陆正齐. 动脉硬化性脑小血管病与阿尔茨海默病认知功能损害特征的比较[J]. 中国卒中杂志, 2020, 15(04): 349-353.

References

[1] PANTONI L. Cerebral small vessel disease：from

pathogenesis and clinical characteristics to

therapeutic challenges[J]. Lancet Neurol，2010，9

（7）：689-701.

[2] BROWN R，BENVENISTE H，BLACK S E，et

al. Understanding the role of the perivascular space

in cerebral small vessel disease[J]. Cardiovasc Res，

2018，114（11）：1462-1473.

[3] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国脑小血管病诊治共识[J]. 中华

神经科杂志，2015，48（10）：838-844.

[4] GORELICK P B，SCUTEFI A，BLACK S E，et al.

Vascular contributions to cognitive impairment and

dementia：a statement for healthcare professionals

from the American Heart Association / American

Stroke Association[J]. Stroke，2011，42（9）：2672-

2713.

[5] MCKHANN G M，KNOPMAN D S，CHERTKOW

H，et al. The diagnosis of dementia due to

Alzheimer's disease：recommendations from the

National Institute on Aging-Alzheimer's Association

workgroups on diagnostic guidelines for Alzheimer's

disease[J]. Alzheimers Dement，2011，7（3）：263-

269.

[6] FOLSTEIN M F，FOLSTEIN S E，MCHUGH P R.

"Mini-mental state". A practical method for grading

the cognitive state of patients for the clinician[J]. J

Psychiatr Res，1975，12（3）：189-198.

[7] NASREDDINE Z S，PHILLIPS N A，BÉDIRIAN V，

et al. The Montreal Cognitive Assessment，MoCA：a

brief screening tool for mild cognitive impairment[J].

J Am Geriatr Soc，2005，53（4）：695-699.

[8] 刘扬，陈伟红，李睿. 高血压引起脑小血管病可致认

知障碍[J]. 中风与神经疾病杂志，2018，35（1）：94-

96.

[9] CHIANG G C，CRUZ HERNANDEZ J C，

KANTARCI K，et al. Cerebral microbleeds，CSF

p-Tau，and cognitive decline：significance of

anatomic distribution[J]. AJNR Am J Neuroradiol，

2015，36（9）：1635-1641．

[10] KALARIA R N. Vascular basis for brain

degeneration：faltering controls and risk factors for

dementia[J]. Nutr Rev，2010，68（Suppl 2）：S74-S87.

[11] AXELSSON J，REINPRECHT F，SIENNICKILANTZ

A，et al. Low ambulatory blood pressure is

associated with lower cognitive function in healthy

elderly men[J]. Blood Press Monit，2008，13（5）：

269-275.

[12] KIVIPELTO M，NGANDU T，FRATIGLIONI L，et

al. Obesity and vascular risk factors at midlife and

the risk of dementia and Alzheimer disease[J]. Arch

Neurol，2005，62（10）：1556-1560.

[13] BROOKES R L，HANNESDOTTIR K，MARKUS

H S，et al. Lack of awareness of neuropsychological

deficit in cerebral small vessel disease：the

relationship with executive and episodic memory

functions[J]. J Neuropsychol，2013，7（1）：19-28.

[14] FLETCHER E，GAVETT B，HARVEY D，et al.

Brain volume change and cognitive trajectories in

aging[J]. Neuropsychology，2018，32（4）：436-449.

[15] ALJONDI R，SZOEKE C，STEWARD C，et al. A

decade of changes in brain volume and cognition[J].

Brain Imaging Behav，2019，13（2）：554-563.

[16] BANERJEE G，KIM H J，FOX Z，et al. MRIvisible

perivascular space location is associated

with Alzheimer’s disease independently of amyloid

burden[J]. Brain，2017，140（4）：1107-1116.

[17] DING J，SIGURÐSSON S，JÓNSSON P V，et

al. Space and location of cerebral microbleeds，

cognitive decline，and dementia in the community[J].

Neurology，2017，88（22）：2089-2097.

[18] VAN WESTEN D，LINDQVIST D，BLENNOW

K，et al. Cerebral white matter lesions - associations

with Aβ isoforms and amyloid PET[J]. Sci Rep，2016，

6：20709.

[19] VAN DEN BERG E，GEERLINGS M I，BIESSELS

G J，et al. White matter hyperintensities and

cognition in mild cognitive impairment and

Alzheimer’s disease：a domain-specific metaanalysis[

J]. J Alzheimers Dis，2018，63（2）：515-

527.

[20] YAMAGUCHI Y，WADA M，SATO H，et al. Impact

of ambulatory blood pressure variability on cerebral

small vessel disease progression and cognitive

decline in community-based elderly Japanese[J]. Am

J Hypertens，2014，27（10）：1257-1267.