Martynova O O, Zakharov V V
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(4. Vyp. 2):25-32. doi: 10.17116/jnevro202412404225.
To establish specific features of executive functions (EF) impairment and attention in vascular cognitive impairment (VCI) and Alzheimer's disease (AD).
Eighty people (over the age of 50) diagnosed with cerebrovascular disease (CVD) and AD, as well as 29 healthy volunteers (control group), were examined. The following neuropsychological methods were used to study the quantitative and qualitative characteristics of cognitive impairments: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), EXIT-25, Frontal Assessment Battery (FAB), Clock Drawing Test, «12 Words» test, verbal associations (literal and categorical) method, Trail Making Test A and B, Symbol-Digit Modalities Test (SDMT), Stroop Test, and Benton Visual Retention Test. Mandatory inclusion criteria in the study included having a completed magnetic resonance imaging (MRI) of the brain (in T1, T2, FLAIR, DWI, SWI modes) within 1 year before enrollment in one of the groups.
No significant differences in age, sex, and level of education were found between the groups. Groups AD and CVD were also comparable in the severity of cognitive impairment overall. Attention and working memory deficits were observed in both CVD and AD, with slightly more pronounced deficits in the AD group. Qualitative analysis of individual components of working memory revealed that both CVD and AD groups had comparable cognitive control impairment compared to the control group, while AD was characterized by a more significant decrease in intellectual flexibility compared to CVD. Sustained attention was equally impaired among patients in the CVD and AD groups, with a significant difference from the control group (<0.05). In terms of memory, it was found that auditory-verbal memory and semantic memory were significantly more affected in AD, while visual memory was impaired in both conditions.
Attention and EF impairments are not specific to the «subcortical» type of cognitive disorders. Already in the early stages, AD is characterized by a significant impairment of attention and EF, and such a component of EF as intellectual flexibility suffers at the onset of AD to a greater extent than in VCI. Memory impairments are not specific to AD; already at the onset of VCI, visual memory impairment comparable to AD is noted. The obtained data can be used for early neuropsychological diagnosis and differential diagnosis of dementing cerebral diseases.
确定血管性认知障碍（VCI）和阿尔茨海默病（AD）中执行功能（EF）损害及注意力的具体特征。
对80名年龄超过50岁、被诊断为脑血管疾病（CVD）和AD的患者以及29名健康志愿者（对照组）进行检查。采用以下神经心理学方法研究认知障碍的定量和定性特征：简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）、EXIT-25、额叶评估量表（FAB）、画钟试验、“12个单词”测试、言语联想（字面和分类）法、连线测验A和B、符号数字模式测验（SDMT）、斯特鲁普测验以及本顿视觉保持测验。该研究的强制纳入标准包括在被纳入其中一组前1年内完成脑部磁共振成像（MRI）（T1、T2、液体衰减反转恢复序列、弥散加权成像、磁敏感加权成像模式）。
各组之间在年龄、性别和教育水平方面未发现显著差异。AD组和CVD组在总体认知障碍严重程度方面也具有可比性。在CVD组和AD组中均观察到注意力和工作记忆缺陷，AD组的缺陷略为明显。对工作记忆各个组成部分的定性分析表明，与对照组相比，CVD组和AD组在认知控制方面的损害程度相当，而与CVD组相比，AD组在智力灵活性方面的下降更为显著。CVD组和AD组患者的持续性注意力同样受损，与对照组存在显著差异（<0.05）。在记忆方面，发现听觉言语记忆和语义记忆在AD中受影响更为显著，而在两种情况下视觉记忆均受损。
注意力和EF损害并非“皮质下”型认知障碍所特有。在早期阶段，AD就以注意力和EF的显著损害为特征，并且在AD发病时，EF的智力灵活性这一组成部分比VCI受损程度更大。记忆障碍并非AD所特有；在VCI发病时，就已观察到与AD相当的视觉记忆损害。所获得的数据可用于痴呆性脑部疾病的早期神经心理学诊断和鉴别诊断。
