脑白质病变评价量表在认知功能障碍中的作用
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摘要
目的评估脑白质病变MRI视觉量表之间信度评价,探讨视觉评价量表与认知障碍的关系。方法选取2014年8月至2016年10月于北京天坛医院神经内科住院或门诊的脑白质病变患者100例,由两名医师采用改良Scheltens、Manolio、Fazekas、Ylikoski 4个视觉分级量表分别对脑白质病变严重程度进行评分。不同评估者之间采用Kappa检验进行重测信度检验,不同视觉量间用内部一致性检验采用Cronbachα检测;脑白质病变与认知障碍的关系采用Pearman等级相关分析。采用蒙特利尔认知评估量表(Montreal cognitive assessment,Mo CA)评价认知障碍严重程度。通过线性回归分析评价不同量表的相关性。结果 4个视觉量表的内部一致性检验中,Ylikoski量表和改良Scheltens量表Cronbachα信度系数较高,分别为0.824和0.802。不同评分者对视觉量表的一致性评价,Fazekas量表最高(K=0.782),Manolio量表(K=0.449)最低。4个视觉评价量表与Mo CA视空间及执行力评分(3.67±1.45)、注意力评分(5.01±1.45)、记忆力评分(2.44±1.62)进行相关性分析,改良Scheltens量表与Mo CA的视空间及执行力评分、注意力评分、记忆力评分显著相关(r=-0.564,P<0.01;r=-0.375,P<0.05;r=-0.484,P<0.01)。线性回归分析显示4个不同视觉量表间的相关系数最大值为0.843,最小值为0.706。结论脑白质病变4个视觉分级量表间不仅具有很好的相关性和信度,而且与认知障碍均有相关性。其中,Fazekas量表评估项目简单,临床应用便捷;改良Scheltens量表能够较准确地评估脑白质病变的严重程度,适合观察脑白质病变的进展及其与临床特征之间的关系。
Objective To evaluate the reliability of the visual scale of white matter lesions, and also to explore the correlation between different visual scales and cognition. Method 100 patients with different degrees of white matter lesions were randomly recruited by the two physicians.The modified Scheltens, Manolio, Fazekas and Ylikoski were used to assess the severity of white matter lesions(WMLs). Montreal Cognitive Assessment(Mo CA) was used to evaluate the cognitive function. The re-test reliability between different raters was performed by Kappa values. Cronbachα was detected by internal consistency test. The relationship between WMLs and cognition was analyzed by pearman rank correlation analysis. The linear regression analysis was used to predict the mutual transformation and model of different grades. Result In the internal consistency test of the four visual scales, the Ylikoski scale(α=0.824) and the modified Scheltens(α=0.802) were the best. The consistency of the visual scale was the highest, and the consistency of the visual grading scale was highest Fazekas(K=0.782) and the Manolio rating scale(K=0.449) were poor.(3.67±1.45), attention score(5.01±1.45), and memory score(2.44±1.62) in the correlation analysis of the visual grading scale and Mo CA visual space.(r=-0.564, P <0.01;r=-0.375, P <0.05; r=-0.484, P <0.01), and the Scheltens and Mo CA were significantly correlated with visual spatial and executive scores, attention score and memory score The The linear regression analysis showed that the correlation coefficient between the four visual scales was 0.843 and the minimum was 0.706. Conclusion The four visual grading scales of WMLS not only have good correlation and reliability, but also correlated with cognitive impairment. As for Fazekas scale, although simple, but the clinical application is convenient. The improved Scheltens not only accurately assesses the severity of WMLs, but also has a good correlation with cognitive impairment. It is suitable for observing the progress of WMLs and their relationship to clinical features.
Objective To evaluate the reliability of the visual scale of white matter lesions, and also to explore the correlation between different visual scales and cognition. Method 100 patients with different degrees of white matter lesions were randomly recruited by the two physicians.The modified Scheltens, Manolio, Fazekas and Ylikoski were used to assess the severity of white matter lesions(WMLs). Montreal Cognitive Assessment(Mo CA) was used to evaluate the cognitive function. The re-test reliability between different raters was performed by Kappa values. Cronbachα was detected by internal consistency test. The relationship between WMLs and cognition was analyzed by pearman rank correlation analysis. The linear regression analysis was used to predict the mutual transformation and model of different grades. Result In the internal consistency test of the four visual scales, the Ylikoski scale(α=0.824) and the modified Scheltens(α=0.802) were the best. The consistency of the visual scale was the highest, and the consistency of the visual grading scale was highest Fazekas(K=0.782) and the Manolio rating scale(K=0.449) were poor.(3.67±1.45), attention score(5.01±1.45), and memory score(2.44±1.62) in the correlation analysis of the visual grading scale and Mo CA visual space.(r=-0.564, P <0.01;r=-0.375, P <0.05; r=-0.484, P <0.01), and the Scheltens and Mo CA were significantly correlated with visual spatial and executive scores, attention score and memory score The The linear regression analysis showed that the correlation coefficient between the four visual scales was 0.843 and the minimum was 0.706. Conclusion The four visual grading scales of WMLS not only have good correlation and reliability, but also correlated with cognitive impairment. As for Fazekas scale, although simple, but the clinical application is convenient. The improved Scheltens not only accurately assesses the severity of WMLs, but also has a good correlation with cognitive impairment. It is suitable for observing the progress of WMLs and their relationship to clinical features.
引文
[1]孙丽伟,周卫东,曾庆玉,等.脑白质病变患者认知功能的前瞻性研究[J].中国卒中杂志,2016,3(3):196-200.
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[5]Leonardo P,Anna MB,Giovanni P,et al.Impact of age-related cerebral white matter changes on thetransition to disability-the ladis study:rationale,design and methodology[J].Neuroepidemiology,2005,24(1-2):51-62.
[6]Wahlund LO,Barkhof F,Fazekas F,et al.A new rating scale for age-related white matter changes applicable to MRI and CT[J].Stroke,2001,32(6):1318-1322.
[7]?arac H,Markeljevi?J,Erdelji?V,et al.Signal hyperintensities on brain magnetic resonance imaging in patients with primary Sj?gren syndrome and frequent episodic tension-type headache:relation to platelet serotonin level and disease activity[J].J Neurol Sci,1993,114(8):7-12.
[8]Ylikoski R,Ylikoski A,Erkinjuntti T,et al.White matter changes in healthy elderly persons correlate with attention and speed of mental processing[J].Arch Neurol,1993,50(8):818-824.
[9]Manolio TA,Kronmal RA,Burke GL,et al.Magnetic resonance abnormalities and cardiovascular disease in older adults.The cardiovascular health study[J].Stroke,1994,25(2):318-327.
[10]魏娜,王拥军,张玉梅.脑白质病变4个分级量表的信度研究[J].中国康复理论与实践,2012,18(6):562-565.
[11]Rollins CK,Watson CG,Asaro LA,et al.White matter microstructure and cognition in adolescents with congenital heart disease[J].J Pediatr,2014,165(5):936-944.
[12]Smith EE,Salat DH,Jeng J,et al.Correlations between MRI white matter lesion location and executive function and episodic memory[J].Neurology,2011,76(17):1492-1499.
[13]Albinet CT,Boucard G,Bouquet CA,et al.Processing speed and executive functions in cognitive aging:How to disentangle their mutual relationship?[J].Brain Cogn,2012,79(1):1-11.
[14]Bolandzadeh,Jennifer C Davis,Roger Tam,et al.The association between cognitive function and white matter lesion location in older adults:a systematic review[J].BMC Neurology,2012,12(30):126-136.
[15]Smith EE,Salat DH,Jeng J,et al.Correlations between MRI white matter lesion location and executive function and episodic memory[J].Neurology,2011,76(17):1492-1499.
[16]Kim JH,Hwang KJ,Kim JH,et al.Regional white matter hyperintensities in normal aging,single domain amnestic mild cognitive impairment,and mild Alzheimer’s disease.[J].J Clin Neurosci,2011,18(8):1101-1106.
[17]Kapeller P,Barber R,Vermeulen RJ,et al.Visual rating of age-related white matter changes on magnetic resonance imaging[J].Stroke,2003,34(2):441-445.
[18]张秋娟,杨军乐,郭佑民,等.脑白质病变MRI视觉分级方法的比较[J].第四军医大学学报,2008,29(3):273-276.
[19]Yu L,Boyle,Lei Y,et al.White matter hyperintensities,incident mild cognitive impairment,and cognitive decline in old age[J].Ann Clin Transl Neurol,2016,3(10):791-800.
[2]Rollins CK,Watson CG,Asaro LA,et al.White matter microstructure and cognition in adolescents with congenital heart disease[J].J Pediatr,2014,165(5):936-944.
[3]Tuladhar AM,Van Dijk E,Zwiers MP,et al.Structural network connectivity and cognition in cerebral small vessel disease[J].Hum Brain Mapp,2015,37(1):300-310.
[4]M?ntyl?R,Erkinjuntti T,Salonen O,et al.Variable agreement between visual rating scales for white matter hyperintensities on MRI:comparison of 13 rating scales in a poststroke cohort[J].Stroke,1997,28(8):1614-1623.
[5]Leonardo P,Anna MB,Giovanni P,et al.Impact of age-related cerebral white matter changes on thetransition to disability-the ladis study:rationale,design and methodology[J].Neuroepidemiology,2005,24(1-2):51-62.
[6]Wahlund LO,Barkhof F,Fazekas F,et al.A new rating scale for age-related white matter changes applicable to MRI and CT[J].Stroke,2001,32(6):1318-1322.
[7]?arac H,Markeljevi?J,Erdelji?V,et al.Signal hyperintensities on brain magnetic resonance imaging in patients with primary Sj?gren syndrome and frequent episodic tension-type headache:relation to platelet serotonin level and disease activity[J].J Neurol Sci,1993,114(8):7-12.
[8]Ylikoski R,Ylikoski A,Erkinjuntti T,et al.White matter changes in healthy elderly persons correlate with attention and speed of mental processing[J].Arch Neurol,1993,50(8):818-824.
[9]Manolio TA,Kronmal RA,Burke GL,et al.Magnetic resonance abnormalities and cardiovascular disease in older adults.The cardiovascular health study[J].Stroke,1994,25(2):318-327.
[10]魏娜,王拥军,张玉梅.脑白质病变4个分级量表的信度研究[J].中国康复理论与实践,2012,18(6):562-565.
[11]Rollins CK,Watson CG,Asaro LA,et al.White matter microstructure and cognition in adolescents with congenital heart disease[J].J Pediatr,2014,165(5):936-944.
[12]Smith EE,Salat DH,Jeng J,et al.Correlations between MRI white matter lesion location and executive function and episodic memory[J].Neurology,2011,76(17):1492-1499.
[13]Albinet CT,Boucard G,Bouquet CA,et al.Processing speed and executive functions in cognitive aging:How to disentangle their mutual relationship?[J].Brain Cogn,2012,79(1):1-11.
[14]Bolandzadeh,Jennifer C Davis,Roger Tam,et al.The association between cognitive function and white matter lesion location in older adults:a systematic review[J].BMC Neurology,2012,12(30):126-136.
[15]Smith EE,Salat DH,Jeng J,et al.Correlations between MRI white matter lesion location and executive function and episodic memory[J].Neurology,2011,76(17):1492-1499.
[16]Kim JH,Hwang KJ,Kim JH,et al.Regional white matter hyperintensities in normal aging,single domain amnestic mild cognitive impairment,and mild Alzheimer’s disease.[J].J Clin Neurosci,2011,18(8):1101-1106.
[17]Kapeller P,Barber R,Vermeulen RJ,et al.Visual rating of age-related white matter changes on magnetic resonance imaging[J].Stroke,2003,34(2):441-445.
[18]张秋娟,杨军乐,郭佑民,等.脑白质病变MRI视觉分级方法的比较[J].第四军医大学学报,2008,29(3):273-276.
[19]Yu L,Boyle,Lei Y,et al.White matter hyperintensities,incident mild cognitive impairment,and cognitive decline in old age[J].Ann Clin Transl Neurol,2016,3(10):791-800.