Abstract:

Objective  To investigate the value of combining neuropsychological tests with auditory event-related potential (ERP) P300 for cognitive assessment in elderly patients with cerebral small vessel disease (cSVD).  Methods  A total of 183 elderly patients with cSVD were enrolled in this study. They were divided into 3 groups according to brain MRI: lacunar infarct (LACI) group (N = 62), white matter hyperintensity (WMH) group (N = 60) and LACI + WMH group (N = 61). A total of 50 brain MRI normal persons were selected as control group. Montreal Cognitive Assessment (MoCA, Chinese version) was used to evaluate the cognitive function, and the amplitude and latency of P300 were measured in each group.  Results  Compared with control group, the MoCA total score in LACI, WMH and LACI + WMH groups were significantly lower (P = 0.042, 0.015, 0.000), and the score in LACI + WMH group was significantly lower than that in LACI and WMH groups (P = 0.001, 0.042). In the eight cognitive domains of MoCA scale, the visual space and executive function (P = 0.006, 0.041, 0.035), delayed memory (P = 0.006, 0.012, 0.048), language (P = 0.001, 0.032, 0.047) and calculation (P = 0.009, 0.001, 0.003) in LACI + WMH group were significantly lower than those in control, LACI and WMH groups. The delayed memory in LACI group was significantly lower than that in control group (P = 0.037). The delayed memory (P = 0.005) and language (P = 0.047) in WMH group were significantly lower than those in control group. Compared with control group, the amplitudes of P300 (P = 0.025, 0.033, 0.000) in LACI, WMH and LACI + WMH groups were significantly decreased, and the latencies (P = 0.018, 0.000, 0.000) were significantly prolonged. The amplitude of P300 in LACI + WMH group was significantly lower than that in LACI and WMH groups (P = 0.041, 0.018), and the latency was significantly prolonged (P = 0.000, 0.022).  Conclusions  Elderly patients of cSVD all suffer from different degrees of cognitive impairment, especially those with both LACI and WMH. The impaired cognitive domains mainly include visual space and executive function, delayed memory, language and calculation. MoCA scale and P300 examination have their advantages in cognitive assessment, and their combination shows more objective result. Early diagnosis of cSVD in elderly patients with MoCA and P300 is beneficial to timely treatment, delay the progression of this disease and ease the family and social burden.

Key words: Cerebrovascular disorders, Arterioles, Venules, Cognition disorders, Neuropsychological tests, Event-related potentials, P300

摘要：

目的  探讨神经心理学测验联合听觉事件相关电位P300 对老年脑小血管病患者认知功能评价的临床价值。方法 共183例老年脑小血管病患者据头部MRI表现分为腔隙性梗死组（LACI组，62 例）、脑白质高信号组（WMH 组，60 例）和二者兼有组（LACI + WMH 组，61 例），蒙特利尔认知评价量表（MoCA）中文版评价认知功能，检测听觉事件相关电位P300 波幅和潜伏期。结果 LACI 组、WMH 组和LACI + WMH 组MoCA 量表总评分均低于对照组（P = 0.042，0.015，0.000），LACI + WMH 组亦低于LACI组和WMH 组（P = 0.001，0.042）。在MoCA 量表8 个认知域中，LACI + WMH 组视空间能力和执行功能评分（P = 0.006，0.041，0.035）、延迟记忆评分（P = 0.006，0.012，0.048）、言语功能评分（P = 0.001，0.032，0.047）和计算力评分（P = 0.009，0.001，0.003）均低于对照组、LACI 组和WMH 组，LACI 组延迟记忆评分低于对照组（P = 0.037），WMH 组延迟记忆评分（P = 0.005）和言语功能评分（P = 0.047）低于对照组。与对照组相比，LACI 组、WMH 组和LACI + WMH 组P300 波幅均降低（P = 0.025，0.033，0.000）、潜伏期均延长（P = 0.018，0.000，0.000），LACI + WMH 组P300 波幅亦低于LACI 组和WMH 组（P = 0.041，0.018）、潜伏期亦长于LACI组和WMH 组（P = 0.000，0.022）。结论 老年脑小血管病患者均存在不同程度认知功能障碍，主要表现在视空间能力和执行功能、延迟回忆、言语功能和计算力方面，尤以腔隙性梗死和脑白质高信号兼有患者显著。MoCA 量表和听觉事件相关电位P300 评价认知功能优势互补，二者联合可以更客观、早期发现老年脑小血管病患者认知功能障碍，对及时干预、延缓疾病进展、减轻家庭和社会负担具有重要临床意义。

关键词: 脑血管障碍, 小动脉, 小静脉, 认知障碍, 神经心理学测验, 事件相关电位, P300