神经心理学测验联合听觉事件相关电位P300评价老年脑小血管病患者认知功能临床研究

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.