脑白质高信号与阿尔茨海默病患者认知障碍程度及认知内容的相关性分析

Association of white matter hyperintensities with the severity and content of cognitive impairment in patients with Alzheimer disease

摘要:

目的 探讨脑白质高信号（WMH）与阿尔茨海默病（AD）患者认知障碍程度及认知内容的相关性。方法 纳入2022年1月至2024年12月在河北港口集团有限公司秦皇岛中西医结合医院诊治的168例AD患者作为AD组，纳入同一时间段的健康人员168例作为对照组。所有受试者采集头部磁共振成像（MRI）和简易精神状态检查量表（MMSE）评分，比较不分组患者的WMH，比较AD组韩国痴呆症临床研究中心（CREDOS）视觉评定量表评分不同分级患者的认知功能，采用斯皮尔曼等级相关分析WMH体积与认知功能以及认知内容的关系。结果 AD组患者深部皮质下白质高信号（DWMH）、脑室旁白质高信号（PVWMH）以及总体WMH水平高于对照组（P<0.05）。AD组168例患者中，轻、中、重度认知障碍患者的DWMH、PVWMH以及总体WMH水平比较，差异具有统计学意义（P<0.05），其中重度认知障碍患者高于轻度和中度患者（P<0.05），而轻度与中度患者比较差异无统计学意义（P>0.05）。CREDOS评分对DWMH和PVWMH进行分级，结果发现D1、D2、D3级患者MMSE总分以及各分量表评分差异无统计学意义（P>0.05），P1、P2、P3级患者MMSE总分以及定向力、记忆力、语言能力、执行能力、注意力和计算力等认知内容差异具有统计学意义（P<0.05），其中P3级患者评分最低，P1级患者评分最高。斯皮尔曼等级相关分析结果发现，PVWMH与定向力、记忆力、注意力和计算力以及总分呈负相关（P<0.05）。结论 PVWMH水平与AD患者认知障碍密切相关，PVWMH水平可作为AD认知障碍的预测因子。

Abstract:

Objective To investigate the association of white matter hyperintensities （WMH） with the severity and specific cognitive domains of cognitive impairment in patients with Alzheimer disease （AD）.Methods A total of 168 AD patients who were diagnosed and treated in Qinhuangdao Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to December 2024 were enrolled as AD group， and 168 healthy individuals during the same period of time were enrolled as control group. Head magnetic resonance imaging （MRI） data and Mini-Mental State Examination （MMSE） score were collected from all subjects， and WMH was compared between the two groups. Cognitive function was compared between AD patients with different Clinical Research Center for Dementia of South Korea （CREDOS） scores， and a Spearman rank correlation analysis was used to investigate the association of WMH volume with cognitive function and specific cognitive domains.Results Compared with the control group， the AD group had significantly higher levels of deep white matter hyperintensities （DWMH）， periventricular white matter hyperintensities （PVWMH）， and total WMH （P<0.05）. Among the 168 AD patients， there were significant differences in the levels of DWMH， PVWMH， and total WMH between the patients with mild， moderate， and severe cognitive impairment （P<0.05）； the patients with severe cognitive impairment had significantly higher levels than those with mild and moderate cognitive impairment （P<0.05）， while there were no significant differences between the patients with mild and moderate cognitive impairment （P>0.05）. When CREDOS score was used for the grading of DWMH and PVWMH， the results showed that there were no significant differences in total MMSE score and the scores of each subscale between the patients with D1， D2， and D3 grades （P>0.05）； however， there were significant differences in total MMSE score and the scores of cognitive domains such as orientation， memory， language ability， executive function， attention， and calculation ability between the patients with P1， P2， and P3 grades （P<0.05）， with the lowest scores in the patients with P3 grade and the highest scores in those with P1 grade. The Spearman rank correlation analysis showed that PVWMH was negatively correlated with total MMSE score and the scores of orientation， memory， attention， and calculation ability （P<0.05）.Conclusions The level of PVWMH is closely associated with cognitive dysfunction in AD patients and can be used as a predictive factor for cognitive impairment in AD.