晚发抑郁伴轻度认知功能损害患者随访一年认知变化及静息态脑功能局部低频振幅研究

A Study of a Year of Cognitive Change and Local Low-Frequency Amplitude of Brain Function in Patients with Late-Onset Depression with Mild Cognitive Impairment

摘要: 目的：探讨晚发性抑郁症(LOD)伴轻度认知功能损害(MCI)患者随访一年认知功能及全脑分数低频振荡振幅(fALFF)变化。方法：门诊随机选择LOD患者25例，分别在入组时和一年后进行简易智能状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、修订后的成套神经心理测试(NTB)以及静息态磁共振检查，并用DPARSFA软件计算被试随访前后全脑fALFF值，一年后完成随访22例，其中LOD伴MCI组(10例)，LOD不伴MCI组(12例)，采用两配对样本t检验比较各组随访前后各项认知功能，全脑fALFF值差异。结果：LOD伴MCI组于入组时和一年后在MoCA复制图形、持续注意、NTB数字广度测验比较差异有统计学意义(P < 0.05)，而LOD不伴MCI组在NTB听觉学习测验1、联想学习测验2比较差异有显著统计学意义(P < 0.01)。LOD伴MCI患者入组时、比较随访一年后右侧额上回fALFF值比较差异有统计学意义(P < 0.05)。LOD不伴MCI患者入组时、比较随访一年后左侧枕中回、双侧额中上回、左侧顶上回/顶下回/楔前叶分fALFF值比较差异有统计学意义(P < 0.05)。结论：持续注意障碍是加速LOD伴MCI患者向痴呆转化的主要认知变化，同时右侧前额叶脑功能有代偿性激活的现象，左侧枕中回、双侧额中上回、左侧顶上回/顶下回/楔前叶等多个脑区的fALFF下降预示着LOD不伴MCI患者有向AD转变的潜在风险。

Abstract: Objective: To investigate the changes of the cognitive function and the low frequency oscillation amplitude (fALFF) of the whole brain fraction of the patients with mild cognitive impairment (MCI) with mild cognitive impairment (LOD). Methods: 25 patients with LOD were selected from outpatient department into the group. They were requested to determine Mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), Revised neuropsychological test battery (NTB) and Resting-state function magnetic resonance imaging (rs-fMRI) when joining the group and one year later. Finally 22 cases were completed including LOD with MCI group (10 cases) and LOD without MCI group (12 cases). The values of cognitive function and fALFF before and after the follow-up were compared with two-paired sample t-test. Results: In LOD with MCI group, MoCA replication graph, continuous attention, and NTB digital width test comparison between when joining the group and a year later has statistical significance (P < 0.05); while LOD without MCI group in auditory learning test 1 and associative learning test 2 has statistical significance (P < 0.01). LOD with MCI was followed up a year later. The comparison of fALFF values between the right frontal gyrus and the right frontal gyrus was statistically significant (P < 0.05). The difference of the fALFF value (P < 0.05) was statistically significant when the LOD was not in group MCI patients, compared with the left occipital back in one year, the back of the two-lateral frontal gyrus, and the back of the left side of the left. Conclusion: Sustained attention obstacle is the main cognitive change accelerating dementia of MCI with LOD patients, and at the same time the right prefrontal function is the phenomenon of vicarious activation; in return, fALFF decline in the left side of the pillow last time in the bilateral frontal, top left on the top of the back/next/precuneus in multiple regions heralds that patients of LOD without MCI have the potential risks transferring to AD.