认知储备和心理弹性与脑白质高信号患者认知功能的关系。
Associations of cognitive reserve and psychological resilience with cognitive functioning in subjects with cerebral white matter hyperintensities.
机构信息
Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
出版信息
Eur J Neurol. 2021 Aug;28(8):2622-2630. doi: 10.1111/ene.14910. Epub 2021 May 25.
BACKGROUND AND PURPOSE
Cerebral small vessel disease is characterized by progressive white matter hyperintensities (WMH) and cognitive decline. However, variability exists in how individuals maintain cognitive capabilities despite significant neuropathology. The relationships between individual cognitive reserve, psychological resilience and cognitive functioning were examined in subjects with varying degrees of WMH.
METHODS
In the Helsinki Small Vessel Disease Study, 152 subjects (aged 65-75 years) underwent a comprehensive neuropsychological assessment, evaluation of subjective cognitive complaints and brain magnetic resonance imaging with volumetric WMH evaluation. Cognitive reserve was determined by education (years) and the modified Cognitive Reserve Scale (mCRS). Psychological resilience was evaluated with the Resilience Scale 14.
RESULTS
The mCRS total score correlated significantly with years of education (r = 0.23, p < 0.01), but it was not related to age, sex or WMH volume. Together, mCRS score and education were associated with performance in a wide range of cognitive domains including processing speed, executive functions, working memory, verbal memory, visuospatial perception and verbal reasoning. Independently of education, the mCRS score had incremental predictive value on delayed verbal recall and subjective cognitive complaints. Psychological resilience was not significantly related to age, education, sex, WMH severity or cognitive test scores, but it was associated with subjective cognitive complaints.
CONCLUSIONS
Cognitive reserve has strong and consistent associations with cognitive functioning in subjects with WMH. Education is widely associated with objective cognitive functioning, whereas lifetime engagement in cognitively stimulating leisure activities (mCRS) has independent predictive value on memory performance and subjective cognitive complaints. Psychological resilience is strongly associated with subjective, but not objective, cognitive functioning.
背景与目的
脑小血管病的特征是进行性白质高信号（WMH）和认知能力下降。然而，尽管存在明显的神经病理学改变，个体保持认知能力的能力存在差异。本研究旨在探讨不同程度脑小血管病患者个体认知储备、心理弹性与认知功能之间的关系。
方法
在赫尔辛基脑小血管病研究中，152 名（年龄 65-75 岁）受试者接受了全面的神经心理学评估、主观认知抱怨评估和脑磁共振成像，包括容积 WMH 评估。认知储备通过教育年限（年）和改良认知储备量表（mCRS）确定。心理弹性采用韧性量表 14 进行评估。
结果
mCRS 总分与教育年限显著相关（r=0.23，p<0.01），但与年龄、性别或 WMH 体积无关。mCRS 评分和教育程度共同与一系列广泛的认知领域的表现相关，包括加工速度、执行功能、工作记忆、言语记忆、视空间感知和言语推理。独立于教育程度，mCRS 评分对延迟言语回忆和主观认知抱怨具有增量预测价值。心理弹性与年龄、教育程度、性别、WMH 严重程度或认知测试分数无关，但与主观认知抱怨有关。
结论
认知储备与脑小血管病患者的认知功能有很强的一致性。教育程度与客观认知功能广泛相关，而终身参与认知刺激的休闲活动（mCRS）对记忆表现和主观认知抱怨有独立的预测价值。心理弹性与主观认知功能密切相关，而与客观认知功能无关。
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