Zhao Yanwei, Wu Gang, Shi Haiming, Xia Zhijie, Sun Tao
Emergency Department, Huashan Hospital North, Fudan University, Shanghai, People's Republic of China.
Emergency Department, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Clin Interv Aging. 2014 Jul 28;9:1223-31. doi: 10.2147/CIA.S63567. eCollection 2014.
The purpose of this study was to determine a new method for the early diagnosis and assessment of mild cognitive impairment in elderly individuals with hypertension. Elderly hypertensive patients with cognitive impairment were assessed by the Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating Assessment (CDR). Cognitive results were compared to apparent diffusion coefficient (ADC) values from magnetic resonance-diffusion weighted imaging.
A total of 191 patients were categorized into four groups: a control group (normal cognition and no hypertension; n=20); a normal group (hypertension and normal cognition; n=33); an mild cognitive impairment group (n=80); and a vascular dementia group (n=58). The MoCA and CDR tests were used to determine cognition. ADC values in eight brain regions were calculated with magnetic resonance-diffusion weighted imaging. Other characteristics were evaluated, eg, blood pressure, MoCA, and CDR scores, and the comparisons of the four groups were made.
The MoCA and CDR scores differed among the four groups (P<0.001). Systolic and diastolic blood pressure values increased as cognitive function declined (P<0.001). Cognitive function declined as ADC values increased, and they differed between elderly people with and without hypertension (P<0.001). Among elderly hypertensive participants, ADC values were significantly increased in the cortex and hippocampus.
The MoCA and CDR tests were sufficiently sensitive to evaluate cognition. Blood pressure was closely related to cognition, as well as to functional and structural changes in the brain. These alterations were evidenced through changes in the ADC values and were most obvious in the cortex and hippocampus. Greater cognitive decline was observed in elderly participants with hypertension compared to those without. As hypertensive stage increased, greater ADC values were observed.
本研究的目的是确定一种用于早期诊断和评估老年高血压患者轻度认知障碍的新方法。通过蒙特利尔认知评估量表（MoCA）和临床痴呆评定量表（CDR）对患有认知障碍的老年高血压患者进行评估。将认知结果与磁共振扩散加权成像的表观扩散系数（ADC）值进行比较。
总共191名患者被分为四组：对照组（认知正常且无高血压；n = 20）；正常组（高血压且认知正常；n = 33）；轻度认知障碍组（n = 80）；血管性痴呆组（n = 58）。使用MoCA和CDR测试来确定认知情况。通过磁共振扩散加权成像计算八个脑区的ADC值。评估其他特征，例如血压、MoCA和CDR评分，并对四组进行比较。
四组之间的MoCA和CDR评分存在差异（P < 0.001）。收缩压和舒张压值随着认知功能下降而升高（P < 0.001）。认知功能随着ADC值升高而下降，并且在有高血压和无高血压的老年人之间存在差异（P < 0.001）。在老年高血压参与者中，皮质和海马体的ADC值显著升高。
MoCA和CDR测试对评估认知具有足够的敏感性。血压与认知以及大脑的功能和结构变化密切相关。这些改变通过ADC值的变化得以证明，并且在皮质和海马体中最为明显。与无高血压的老年参与者相比，有高血压的老年参与者观察到更大程度的认知下降。随着高血压阶段的增加，观察到更高的ADC值。
