脑小血管病患者伴发非痴呆血管性认知功能损害情况及尼莫地平疗效的研究

摘要

目的 探讨脑小血管病(cerebral small vessel disease,SVD)不同亚型伴发非痴呆血管性认知功能损害的情况,评价尼莫地平对SVD的疗效.方法 选择SVD患者118例,包括52例腔隙灶脑梗死(LI)和66例白质疏松(WML)患者.分别将LI组和WML组患者随机分组为治疗组(基础治疗加尼莫地平治疗)和对照组(基础治疗),进行6个月治疗.治疗前后对所有患者采用蒙特利尔认知评估量表( MoCA)、简易智能状态检查表(MMSE)、语义分类流畅测验(动物)、St roop测验(计算错误数)、画钟试验、积木测验、数字广度顺背测验、数字符号测验、逻辑记忆亚测验和再生亚测验进行认知功能评价,并比较各组患者治疗前后认知功能评分.结果 治疗前,LI组患者语义分类流畅测验(动物)、数字符号测验、逻辑记忆亚测验、视觉再生亚测验、MoCA、MMSE评分显著高于WML组患者,Stroop测验得分显著低于WML组患者.经过6个月治疗后,LI组和WML组患者中的对照组治疗前后各项认知功能评分均没有统计学差异(P＞0.0S).LI组患者中治疗组MoCA、画钟试验和数字广度顺背测验得分升高,Stroop测验得分下降(均P＜0.05)；WML组患者中治疗组MoCA、MMSE、画钟试验、数字广度顺背测验和视觉再生亚测验得分升高,Stroop测验得分下降(均P＜0.05).结论 SVD两个亚型伴发非痴呆血管性认知功能损害情况不同,LI患者损害程度比WML患者轻.尼莫地平治疗可较好的改善患者的执行功能、视空间结构能力和注意力.%Objective To explore the neuropsychological difference of vascular cognitive impairment no dementia in two subtpyes of cerebral small vessel disease (SVD) patients and to evaluate the therapeutic effects of nimodipine on the disease. Methods A total of 118 SVD patients, including 52 Lacunar Infarction (LI) and 66 White Matter Lesion (WML) patients, were enrolled. The patients were divided into experimental group and control group randomly. The patients in the experimental group were treated with nimodipine 90 mg/d for six months, combined with basic treatments while the control group just got basic treatment. Before and after the treatment, the neuropsychological evaluations were performed with mini-mental state examination (MMSE), montreal cognitive assessment (MoCA), semantic category verbal fluency test (animals) , stroop test (calculation mistakes), Chinese version of Wechsler adult intelligence scale (block design, digit span, digit sign), clock drawing test, and Webster' s memory scale (logic and memory test, regeneration test). The neuropsychological characteristics in LI and WML patients, the scores of cognitive impairment assessment before and after the treatment were compared with t tests. Results Before the trealment, the scores of semantic category verbal fluency test (animals), digit sign, logic and memory test, regeneration test, MoCA, and MMSE were higher, and the scores of stroop test were lower in LI patients than in WML patients. After six-month treatment, the scores in all the tests did not show significant change in control group (P>0. 05). However, after the treatment of nimodipine in experimental group, the scores of MoCA, clock drawing test, and digit span increased, while the rnscores of stroop test decreased significantly in LI patients (P<0. 05), In WML patients, the scores of MoCA, MMSE. clock drawing test, digit span, and regeneration test elevated, while the scores of stroop test declined significantly (P<0.05). Conclusions The degree of vascular cognitive impairment no dementia is different between the two subtypes of SVD, and the cognitive impairment in LI patients is not as severe as that in WML patients. Nimodipine is effective in the treatment of vascular cognitive impairment no dementia in SVD patients mainly because it helps to improve the executive function, space structure capacity, and attentiveness.