脑小血管病患者神经心理及认知障碍的危险因素分析-现代医学

脑小血管病患者神经心理及认知障碍的危险因素分析

单位：1. 南京理工大学, 江苏南京 210094;
2. 南京鼓楼医院神经内科, 江苏南京 210008

分类号：R743

出版年·卷·期（页码）：2025·53·第十期（1549-1556）

摘要：

目的：探讨脑小血管病(CSVD)患者的神经心理状态及发生认知障碍的危险因素。方法：回顾性分析2020年10月至2023年12月于南京鼓楼医院和南京理工大学医院就诊的241例CSVD患者的临床资料，根据是否出现认知障碍分为认知障碍组(n=168)和非认知障碍组(n=73)。采用Pearson相关分析评价CSVD患者蒙特利尔认知评估量表(MoCA)评分与简易智力状态检查量表(MMSE)评分、年龄、汉密尔顿焦虑量表(HAMA)评分及汉密尔顿抑郁评定量表17项(HAMD-17)评分的关系。比较两组临床风险因素，明确CSVD发生认知障碍的风险因素。结果：本研究纳入241例CSVD患者，认知障碍发生率为69.71%(168/241)。CSVD患者的MoCA评分与MMSE评分(r=0.720，P＜0.001)呈正相关，与年龄(r=-0.140，P＜0.05)、HAMA评分(r=-0.215，P＜0.01)和HAMD-17评分(r=-0.280，P＜0.001)呈负相关。多因素Logistic回归分析显示，年龄(OR=1.054，95%CI 1.016～1.093)、高血压(OR=2.116，95%CI 1.096～4.084)是CSVD患者发生认知障碍的危险因素，受教育年限(OR=0.749，95%CI 0.677～0.828)是CSVD患者发生认知障碍的保护因素。结论：CSVD患者的认知功能水平与焦虑、抑郁程度呈负相关，年龄、高血压及受教育年限与CSVD患者发生认知障碍密切相关。本研究为CSVD患者预防和干预认知障碍提供了有力的理论依据，具备较强的临床应用前景。

Objective: To investigate the neuropsychological status and risk factors of cognitive impairment in patients with cerebral small vessel disease(CSVD). Methods: The clinical data of 241 CSVD patients who were admitted to Nanjing Drum Tower Hospital and Nanjing University of Science and Technology Hospital from October 2020 to December 2023 were retrospectively analyzed. According to the presence or absence of cognitive impairment, they were divided into cognitive impairment group(n=168) and non-cognitive impairment group(n=73). Pearson correlation analysis was used to evaluate the relationship between MoCA score and MMSE score, age, HAMA score and HAMD-17 score in CSVD patients. The clinical risk factors were compared between the two groups to identify the risk factors for cognitive impairment in cerebral small vessel disease. Results: A total of 241 CSVD patients were included in this study, the incidence of cognitive impairment was 69.71%(168/241). The MoCA score of CSVD patients was positively correlated with MMSE score(r=0.720, P<0.001), and negatively correlated with age(r=-0.140, P<0.05), HAMA score(r=-0.215, P<0.01) and HAMD-17 score(r=-0.280, P<0.001). Multiple Logistic regression analyses showed that age(OR=1.054, 95%CI 1.016-1.093) and hypertension(OR=2.116, 95%CI 1.096-4.084) were the risk factors for cognitive impairment in patients with CSVD, and years of education(OR=0.749, 95%CI 0.677-0.828) was a protective factor for cognitive impairment in CSVD patients. Conclusion: The cognitive function in CSVD patients is negatively correlated with the degree of anxiety and depression, and age, hypertension and years of education are closely related to the occurrence of cognitive impairment in CSVD patients. The study provides a strong theoretical basis for the prevention and intervention of cognitive impairment in CSVD patients and has strong clinical application prospects.

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