以精神行为异常为主要症状的非痴呆型血管性认知障碍临床研究

摘要

目的：分析以精神行为异常为主要症状的非痴呆型血管认知障碍（vascular cognitive impairment no dementia，VCIND）的精神行为特点和认知功能特征。方法本研究为横断面研究，收集2011年6月～2013年12月广州市脑科医院以精神行为异常为主要症状就诊的VCIND18例、伴有精神行为异常的血管性痴呆（vascular dementia，VaD）16例和无认知功能障碍（no cognitive impairment，NCI）18例作为对照组。采用神经精神科问卷（Neuropsychiatric Inventory， NPI）和简易精神状态检查量表（Mini-Mental State Examination，MMSE）及蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）分别评定精神行为和认知状态，并比较各组间精神行为及认知状态的差异。结果 VCIND组最多见的精神行为异常表现为易激惹/情绪不稳（66.7%），睡眠障碍（61.1%），其次为激越/攻击行为（55.6%），幻觉/妄想（44.4%）。VaD组焦虑/抑郁症状与VCIND组相比较多见，差异具有显著性（75% vs 16.7%；P=0.001）。VCIND组各认知评分介于VaD组和NCI组之间，与NCI组相比，在视空间/执行能力（2.78±0.73 vs 4.50±0.51）、注意（4.61±0.61 vs 5.33±0.48）、语言（2.11±0.47 vs 2.67±0.49）、抽象[1（0，1）vs 2（1，2）]、延迟记忆[2（2，3）vs 4（4，4）]方面差异均具有显著性（P<0.001）。结论 VCIND可以以精神行为异常为主要表现，尤其是急起的易激惹/情绪不稳、睡眠障碍及激越/攻击行为。%Objective To analyze the cognitive and neuropsychiatric features of patients with vascular cognitive impairment no dementia (VCIND). Methods Eighteen VCIND, 16 vascular dementia (VaD) with neuropsychiatric symptoms as the primary manifestation and 18 no cognitive impairment (NCI) who visited in Guangzhou Brain Hospital from June 2011 to December 2013 were evaluated with Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The differences of cognitive state and neuropsychiatric behavior of three groups were compared. Results The most symptom of VCIND patients is irritability/mood unstability (66.7%) and sleep changes (61.1%), followed by agitation/aggressive behavior (55.6%), then hallucination/delusion (44.4%). Anxiety/depression were the most symptoms of VaD patients compared to VCIND (75%vs 16.7%, P=0.001). Cognition function of VCIND patients was between VaD and NCI. Compared to NCI group, the MoCA subtest scores of patients with VCIND was signiifcantly less in visuo-executive (2.78±0.73 vs 4.50±0.51), attention (4.61±0.61 vs 5.33±0.48), language (2.11±0.47 vs 2.67±0.49), abstraction (1[0, 1] vs 2[1, 2]) and delayed recall (2[2, 3] vs 4[4, 4]) (P<0.001). Conclusion Behavioral and psychological symptoms could be as primary manifestation of VCIND patients, specially for acute irritability, sleep changes and agitation/aggressive behavior.