脑白质病变及大脑皮层厚度与老年轻型卒中后认知功能障碍的相关性研究

doi:10.3969/j.issn.1003-9198.2024.03.017

摘要/Abstract

摘要： 目的探讨老年轻型卒中后认知功能障碍(PSCI)与脑白质病变、大脑皮层厚度的关系。方法回顾性分析158例老年轻型卒中病人的临床资料,根据MoCA评估结果分为非PSCI组和PSCI组(MoCA<26分),比较2组的基线资料、MRI影像改变、大脑皮层厚度,并采用多因素Logistic回归分析老年轻型卒中病人发生PSCI的影响因素。结果 PSCI组与非PSCI组的腔隙性缺血灶、脑微出血、DWI阳性病变及血管间隙扩大检出率差异无统计学意义(P>0.05)。PSCI组年龄大于非PSCI组,脑白质病变较非PSCI组严重(P<0.05)。2组的左额下回三角部及右额下回三角部皮质厚度差异无统计学意义(P>0.05),但PSCI组左眶额部、右眶额部、左额中回及右额中回的皮质厚度均明显低于非PSCI组(P<0.05)。多因素分析显示,年龄、中重度脑白质病变均为老年轻型卒中病人发生PSCI的危险因素(OR=1.704、1.826,均P<0.05),前额叶脑皮质厚度(左眶额部、右眶额部、左额中回、右额中回)为老年轻型卒中病人发生PSCI的保护因素(OR=0.820、0.838、0.834、0.827,均P<0.05)。结论年龄、脑白质中重度病变及前额叶脑皮质厚度变薄均与PSCI密切相关,通过头颅MRI检查脑白质及大脑皮质厚度变化,可为临床预测PSCI的发生提供参考依据。

关键词: 卒中后认知功能障碍, 轻型卒中, 脑白质病变, 大脑皮层厚度, 磁共振成像

Abstract: Objective To explore the correlation of white matter lesions and cerebral cortex thickness with cognitive dysfunction after mild stroke in the elderly. Methods A total of 158 elderly patients with mild stroke were selected and divided into non-poststroke cognitive impairment (PSCI) group and PSCI group based on the results of the Montreal Cognitive Assessment Scale (MoCA). The baseline data, MRI images, cerebral cortex thickness of the two groups were compared, and the influencing factors of PSCI for patients with mild stroke were analyzed by multivariate Logistic regression. Results The detection rates of lacunar ischemic lesions, cerebral microbleeds, diffusion weighted imaging (DWI) positive lesions and vascular gap enlargement showed no statistically significant differences between PSCI group and non-PSCI group (P>0.05). The average age of PSCI group was older than that of non-PSCI group, and the severity of white matter lesions was higher than that of non-PSCI group (P<0.05). The cortical thicknesses of the left and right inferior frontal gyrus triangle showed no significant differences between the two groups (P>0.05), but the cortical thicknesses of the left and right orbitofrontal areas, left and right middle frontal gyri in PSIC group were significantly thinner than those in non-PSCI group (P<0.05). Multivariate Logistic regression analysis showed that age and moderate to severe white matter lesions were risk factors for PSCI in the elderly patients with mild stroke (OR=1.704, 1.826, all P<0.05), while prefrontal cortex thickness (left orbitofrontal area, right orbitofrontal area, left frontal gyrus, right frontal gyrus) was a protective factor for PSCI in the elderly patients with mild stroke (OR=0.820, 0.838, 0.834, 0.827, all P<0.05). Conclusions Age, moderate and severe lesions of white matter and the thickness of prefrontal cortex are closely related to PSCI. The status of white matter and cerebral cortex thickness detected by cranial MRI can provide reference for clinical prediction of PSCI.

Key words: poststroke cognitive impairment, mild stroke, white matter lesions of the brain, cerebral cortex thickness, magnetic resonance imaging

中图分类号:

R 749.1

焦琳娜, 李宝仪, 王琴, 何建丽. 脑白质病变及大脑皮层厚度与老年轻型卒中后认知功能障碍的相关性研究[J]. 实用老年医学, 2024, 38(3): 287-290.

JIAO Linna, LI Baoyi, WANG Qin, HE Jianli. Correlation of white matter lesions and cerebral cortex thickness with cognitive dysfunction after mild stroke in the elderly[J]. Practical Geriatrics, 2024, 38(3): 287-290.

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