| Part I Study of neuropsychological characteristics in patients with vascular cognitive impairment no dementiaBackground Vascular cognitive impairment(VCI) include all levels of cognitive decline resulting from cerebrovascular disease (CVD) or risk factors for CVD, ranging from mild deficits in one or more cognitive domains to a broad dementia-like syndrome. Three broad clinical subtypes are included: vascular cognitive impairment no dementia (VCIND), vascular dementia (VD) and mixed dementia. The unified VCI standards recommended by National Institute for Neurological Disorders and Stroke and Canadian Stroke Network(NINDS-CNS) in 2006 and《specialist consensus of vascular cognitive impairment in 2007》of China stressed the importance of VCI and pointed out the direction of clinical research. VCIND is the early stages of VCI, more and more evidences proclaims high-risk of VCIND into dementia, and it is possible that were reversed or stable after treatment. Early diagnosis and intervention the preclinical state of dementia——VCIND, having a great signality in the prevention and treatment of dementia.Objective To investigate the neuropsychological characteristics in patients with vascular cognitive impairment no dementia and get characteristics of their cognitive impairment.Methods 42 patients with VCIND and 45 age-,sex- and education level matched normal controls were tested with a wide neuropsychological battery of tests covering global cognitive function, memory, attention, naming, visual spatial skills and executive function and the results were compared. These neuropsychological tests include Montreal cognitive assessment(MoCA), auditory verbal learning test(AVLT), digital span test(DST), Rey-Osterrieth complex figure test(CFT), semantic and phonetic fluency tests, digit symbol coding subtest(DSCT), trail making test(TMT), Boston naming test(BNT), clock drawing test(CDT) and the Stroop color-word test (SCWT). Informed consent was obtained from all participants and the study was approved by the Ethics Committee.Results The cognitive test scores in multiple domains in VCIND group were significantly lower than those of normal control group. The results were as following: MoCA(19.38±3.18 and 26.71±0.92, F=65.460, P=0.000), AVLT(F=26.218,21.918,25.336,21.968,25.491, all P=0.000), DST(8.07±2.42 and 10.31±2.75, F=4.477, P=0.003), CFT (31.43±2.28 and 33.38±1.64, F=5.659, P=0.000), BNT(21.45±2.47 and 24.04±2.62, F=28.643, P=0.000), in executive function tests, tests to count time: Stroop C(104.81±11.58 and 74.31±15.45, F=34.553, P=0.000), TMT PartA (66.83±3.40 and 61.11±4.11, F=18.773, P=0.000), TMT PartB (261.50±22.51 and 134.71±13.77, F=307.195, P=0.000), tests to count score: Stroop C (43.83±1.74 and 47.44±1.67, F=25.172, P=0.000), DSCT(18.05±4.36 and 41.22±8.27, F=67.564, P=0.000), semantic fluency test(P=0.000,0.175,0.377,0.000,0.000,0.069), phonetic fluency test(P=0.000,0.362,0.052,0.000,0.000,0.437). The scores of CDT in two groups (22.48±2.30 and 25.13±2.76, F=1.482, P=0.227) were not statistically significant.Conclusions1. Current study indicates that there are cognitive impairment in multiple domains including memory, attention, naming, executive function and visual spatial skills in patients with VCIND.2. Executive function impairment manifests outstanding among these domains of cognitive impairment in patients with VCIND, and can be many executive function tests discovered sensitively. Executive function with time limitation is more sensitive. Part II Study of diffusion tensor imaging on thalamus in patients with vascular cognitive impairment no dementiaObjective Using magnetic resonance diffusion tensor imaging (DTI) technology to detect whether any diffusion characteristics abnormalities on thalamus are present in patients with vascular cognitive impairment no dementia (VCIND). To investigate relationship between changes of DTI parameters and cognitive impairment and evaluate its application values in early diagnosis of VCIND.Methods 22 patients and 22 cognitive normal controls were randomly selected from VCIND group including 42 cases and normal control group including 45 cases respectively. With DTI scanning and data was collected to perform post-processing, The values of mean diffusivity(MD) and fractional anisotropy(FA) were measured on both sides of region of interest in thalamus and a quantitative analysis were made on the measured values. Moreover, the correlations between scores of MoCA and MD, FA values were analyzed in VCIND group.Results Compared with control group, the MD values on region of interest of amb-thalamus were significantly increased in VCIND group, and the difference was statistically significant(P<0.05). The FA values in both sides of thalamus showed no significant difference between the two groups(P>0.05). There was a lateralization difference of MD values in VCIND group, the MD values on the left region of interest were higher than the opposite in VCIND group, and the difference was statistically significant(P<0.01). And the MD values between both sides of thalamus compared no significant difference in control group(P>0.05). The FA values between both sides of thalamus compared no significant difference in both groups(P>0.05). There is no significant difference between the two groups about asymmetry index of MD, FA values(P>0.05). A significant negative correlation was present between the MD values in amb-thalamus and the MoCA score(P<0.05), and the FA values in amb-thalamus showed no significant correlation with MoCA score in VCIND group(P>0.05).Conclusions1. The MD values increased abnormally on thalamus in patients with VCIND, DTI technique is helpful for the early diagnosis of VCIND.2. Thalamic lesions may be an early and a crucial link in the pathogenesis of overall cognitive impairment in patients with VCIND. |
PDF Full Text Request