輕度認知功能障礙患者的神經心理學特點初步探討_《華西醫學》

作者：

郎悅 ^1,2 ,  韓瓔 ¹ , 姜長斌 ³ , 宋海慶 ¹ , 閔保全 ¹ , 賈建平 ¹

1 首都醫科大學宣武醫院神經內科（北京，100053）;2 大連醫科大學研究生院，3 附屬第一醫院神經內科;

關鍵詞：

輕度認知障礙癡呆，血管性神經心理量表

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【摘要】　目的　通過比較遺忘型輕度認知障礙（amnestic mild cognitive impairment，aMCI）和血管性認知障礙非癡呆型（vascular cognitive impairment-no dementia，VCI-ND）患者及正常老年人群在簡易智能精神狀態檢查量表（mini mental state examination，MMSE）、聽覺詞語學習測驗（auditory verbal learning test，AVLT）、畫鐘試驗（clock drawing test，CDT）及臨床癡呆評定量表（clinical dementia rating scales，CDR）中的表現，進一步分析aMCI和VCI-ND在認知損害方面的不同特點。　方法　選取首都醫科大學宣武醫院神經內科門診收治aMCI患者23例及VCI-ND患者27例（CDR＝0.5分），同時選取40名正常老年人（CDR=0分）作為對照組。每位受試者均進行MMSE、AVLT、CDT及CDR等神經心理學量表測查，分析以上3組被試各項神經心理學測查得分之間的差異。　結果　各組受試者的年齡、性別及受教育程度差異無統計學意義（P gt;0.05），具有可比性。aMCI和VCI-ND組在MMSE、CDT、即刻記憶、延遲記憶及延遲再認檢測中的平均值均低于對照組，且差異均具有統計學意義（P lt;0.05）。aMCI和VCI-ND兩組除延遲再認檢測外，其余各項測查的平均分均無統計學意義（P gt;0.05）。在延遲再認檢測中，aMCI組（6.65±4.00）較VCI-ND組（8.67±2.76）再認詞語數量少，兩組延遲再認的得分均低于對照組（12.83±1.77），差異有統計學意義（P lt;0.05）。　結論　 aMCI和VCI-ND在記憶力、執行能力和信息處理能力方面較正常老年人均有所損害。由于aMCI和VCI-ND不同的病理改變，導致患者存在不同類型的記憶儲存和提取機制。
【Abstract】　Objective　 To investigate the different patterns of cognitive impairment in patients with amnestic mild cognitive impairment (amci), vascular cognitive impairment-no dementia (VCI-ND) and normal elder people.　Methods　 A total of 23 patients with aMCI and 27 patients with VCI-ND (CDR＝0.5) and another 40 healthy elder people (CDR=0) were selected. Each individual underwent the neuropsychological tests, including mini mental state examination (MMSE), auditory verbal learning test (AVLT), clock drawing test (CDT), clinical dementia rating scales (CDR) and hamilton rating scale for depression (HAMD). The differences between the three groups were analyzed.　Results　 The differences in age, sexes, and the education background among the three groups were not significant (P gt;0.05) which meant comparability. The mean scores of MMSE, CDT, instant memory and delayed awareness in aMCI and VIC-ND group were much lower than that in the control group (P lt;0.05). The differences in all the test items except for delayed awareness between aMCI group and VCI-ND groups were not significant (P gt;0.05). However, in the recall recognition test, these three groups had significant differences: the score in patients with aMCI (6.65±4.00) was much lower than that in patients with VCI-ND (8.67±2.76; P lt;0.05), and the scores of the two groups were both lower than that in the normal aging group (12.83±1.77; P lt;0.05).　Conclusion　 Compared with normal elder people, the cognition of aMCI and VCI-ND patients is impaired severely. The memory tests suggeste that compared with aMCI patients, VCI-ND patients may have different neuropathological changes leading to different mechanism of memory encoding and retrieval.

引用本文： 郎悅,韓瓔,姜長斌,宋海慶,閔保全,賈建平. 輕度認知功能障礙患者的神經心理學特點初步探討. 華西醫學, 2011, 26(1): 8-11. doi: 復制

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13.	Palmer K, Fratiglioni L, Winblad B. What is mild cognitive impairment? Variations in definitions and evolution of nondemented persons with cognitive impairment[J]. Acta Neurol Scand Suppl, 2003, 179: 14-20.
14.	Desmond DW. The cognitive syndrome of vascular dementia: implications for clinical trials. Alzheimer Dis Assoc Disord, 1999, 13 (Suppl 3): 21-29.
15.	Looi JC, Sachdev PS, Differentiation of vascular dementia from AD on neuropsychological tests[J]. Neurology, 1999, 53(4): 670-678.
16.	Garrett KD. The neuropsychological profile of vascular cognitive impairment--no dementia: comparisons to patients at risk for cerebrovascular disease and vascular dementia[J]. Arch Clin Neuropsychol, 2004, 19(6): 745-757.
17.	Troyer AK. Clustering and switching on verbal fluency: the effects of focal frontal- and temporal-lobe lesions[J]. Neuropsychologia, 1998, 36(6): 499-504.
18.	Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) [J]. Lancet, 2001, 357(9251): 169-175.
19.	Desmond DW. Cognition and white matter lesions[J]. Cerebrovasc Dis, 2002, 13 (Suppl 2): 53-57.
20.	Bai F. Default-mode network activity distinguishes amnestic type mild cognitive impairment from healthy aging: a combined structural and resting-state functional MRI study[J]. Neurosci Lett, 2008, 438(1): 111-115.
21.	Royall DR, Cordes JA, Polk M. CLOX: an executive clock drawing task[J]. J Neurol Neurosurg Psychiatry, 1998, 64(5): 588-594.
22.	Kramer JH. Executive dysfunction in subcortical ischaemic vascular disease[J]. J Neurol Neurosurg Psychiatry, 2002, 72(2): 217-220.
23.	Laukka EJ. Similar patterns of cognitive deficits in the preclinical phases of vascular dementia and Alzheimer’s disease[J]. J Int Neuropsychol Soc, 2004, 10(3): 382-391.
24.	Cummings JL. Frontal-subcortical circuits and human behavior[J]. Arch Neurol, 1993, 50(8): 873-880.
25.	Garrard P, Perry R, Hodges JR. Disorders of semantic memory[J]. J Neurol Neurosurg Psychiatry, 1997, 62(5): 431-435.
26.	Jack CR. MR-based hippocampal volumetry in the diagnosis of Alzheimer’s disease. Neurology, 1992, 42(1): 183-188.
27.	Hart J, Gordon B, Delineation of single-word semantic comprehension deficits in aphasia, with anatomical correlation[J]. Ann Neurol, 1990, 27(3): 226-231.

1. 　Desmond DW. Vascular dementia: a construct in evolution[J]. Cerebrovasc Brain Metab Rev, 1996, 8(4): 296-325.
2. 　Petersen RC. Mild cognitive impairment: clinical characterization and outcome[J]. Arch Neurol, 1999, 56(3): 303-308.
3. 　Petersen RC. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology[J]. Neurology, 2001, 56(9): 1133-1142.
4. 　Petersen RC. Mild cognitive impairment as a diagnostic entity[J]. J Intern Med, 2004, 256(3): 183-194.
5. 　Davis HS, Rockwood K. Conceptualization of mild cognitive impairment: a review[J]. Int J Geriatr Psychiatry, 2004, 19(4): 313-319.
6. 　Hachinski V. Vascular dementia: a radical redefinition[J]. Dementia, 1994, 5(3-4): 130-132.
7. 　Stephan BC. Beyond mild cognitive impairment: vascular cognitive impairment, no dementia (VCIND) [J]. Alzheimers Res Ther, 2009, 1(1): 4.
8. 　Rockwood K. Spectrum of disease in vascular cognitive impairment[J]. Neuroepidemiology, 1999, 18(5): 248-254.
9. 　Bowler JV, Steenhuis R, Hachinski V. Conceptual background to vascular cognitive impairment[J]. Alzheimer Dis Assoc Disord, 1999, 13 (Suppl 3): 30-37.
10. 　Nyenhuis DL. The pattern of neuropsychological deficits in vascular cognitive impairment-no dementia (vascular CIND) [J]. Clin Neuropsychol, 2004, 18(1): 41-49.
11. 　Wentzel C. Progression of impairment in patients with vascular cognitive impairment without dementia[J]. Neurology, 2001, 57(4): 714-716.
12. 　Tuokko H. Five-year follow-up of cognitive impairment with no dementia[J]. Arch Neurol, 2003, 60(4): 577-582.
13. 　Palmer K, Fratiglioni L, Winblad B. What is mild cognitive impairment? Variations in definitions and evolution of nondemented persons with cognitive impairment[J]. Acta Neurol Scand Suppl, 2003, 179: 14-20.
14. 　Desmond DW. The cognitive syndrome of vascular dementia: implications for clinical trials. Alzheimer Dis Assoc Disord, 1999, 13 (Suppl 3): 21-29.
15. 　Looi JC, Sachdev PS, Differentiation of vascular dementia from AD on neuropsychological tests[J]. Neurology, 1999, 53(4): 670-678.
16. 　Garrett KD. The neuropsychological profile of vascular cognitive impairment--no dementia: comparisons to patients at risk for cerebrovascular disease and vascular dementia[J]. Arch Clin Neuropsychol, 2004, 19(6): 745-757.
17. 　Troyer AK. Clustering and switching on verbal fluency: the effects of focal frontal- and temporal-lobe lesions[J]. Neuropsychologia, 1998, 36(6): 499-504.
18. 　Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) [J]. Lancet, 2001, 357(9251): 169-175.
19. 　Desmond DW. Cognition and white matter lesions[J]. Cerebrovasc Dis, 2002, 13 (Suppl 2): 53-57.
20. 　Bai F. Default-mode network activity distinguishes amnestic type mild cognitive impairment from healthy aging: a combined structural and resting-state functional MRI study[J]. Neurosci Lett, 2008, 438(1): 111-115.
21. 　Royall DR, Cordes JA, Polk M. CLOX: an executive clock drawing task[J]. J Neurol Neurosurg Psychiatry, 1998, 64(5): 588-594.
22. 　Kramer JH. Executive dysfunction in subcortical ischaemic vascular disease[J]. J Neurol Neurosurg Psychiatry, 2002, 72(2): 217-220.
23. 　Laukka EJ. Similar patterns of cognitive deficits in the preclinical phases of vascular dementia and Alzheimer’s disease[J]. J Int Neuropsychol Soc, 2004, 10(3): 382-391.
24. 　Cummings JL. Frontal-subcortical circuits and human behavior[J]. Arch Neurol, 1993, 50(8): 873-880.
25. 　Garrard P, Perry R, Hodges JR. Disorders of semantic memory[J]. J Neurol Neurosurg Psychiatry, 1997, 62(5): 431-435.
26. 　Jack CR. MR-based hippocampal volumetry in the diagnosis of Alzheimer’s disease. Neurology, 1992, 42(1): 183-188.
27. 　Hart J, Gordon B, Delineation of single-word semantic comprehension deficits in aphasia, with anatomical correlation[J]. Ann Neurol, 1990, 27(3): 226-231.

《華西醫學》

輕度認知功能障礙患者的神經心理學特點初步探討

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《華西醫學》

輕度認知功能障礙患者的神經心理學特點初步探討

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