作者：范琳，刘颖，王正阳，洪伟

单位：

南京医科大学附属泰州人民医院神经内科

Units：

Department of Neurology, the Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China

关键词：

脑梗死; 小脑; 血管性认知障碍; 功能偏侧性;

Keywords：

Brain infarction; Cerebellum; Vascular cognitive impairment; Functional laterality

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.163

Funds：

泰州市科技项目（TS202216）；南京医科大学泰州临床医学院科研项目（TZKY202202）

摘要：

目的 探讨不同侧小脑后叶梗死后血管性认知障碍（VCI）的特点。方法 选取2019年1月至2022年6月于南京医科大学附属泰州人民医院住院的单侧小脑后叶梗死后发生VCI的患者95例，根据小脑后叶梗死侧别将其分为左侧小脑梗死组（n=49）与右侧小脑梗死组（n=46）。同期在社区招募志愿者52例作为对照组。比较三组一般资料、蒙特利尔认知评估量表（Mo CA）评分及其各维度评分（包括执行力评分、记忆评分、注意力评分、语言评分、视空间评分、定向力评分）、波士顿命名测验（BNT）评分、听觉词语延迟回忆测试（RAVLT）评分、连线试验（TMT）结果。结果 对照组Mo CA评分、注意力评分、视空间评分高于左侧小脑梗死组、右侧小脑梗死组，执行力评分、记忆评分、语言评分高于右侧小脑梗死组（P<0.05）；左侧小脑梗死组执行力评分、语言评分高于右侧小脑梗死组（P<0.05）。对照组BNT评分、RAVLT评分高于右侧小脑梗死组，TMT-A完成时间、TMT-B完成时间分别短于左侧小脑梗死组、右侧小脑梗死组（P<0.05）；左侧小脑梗死组BNT评分高于右侧小脑梗死组，TMT-B完成时间短于右侧小脑梗死组（P<0.05）。结论 小脑后叶梗死后VCI具有一定偏侧性，左侧小脑后叶梗死后VCI患者主要表现为注意力和视空间能力降低，右侧小脑后叶梗死后VCI患者表现出更全面的认知功能下降，特别是语言及执行功能降低更明显。

Abstract：

Objective To explore the characteristics of vascular cognitive impairment (VCI) after different lateral cerebellar infarction. Methods A total of 95 patients with VCI after unilateral posterior cerebellar infarction admitted to the Affiliated Taizhou People's Hospital of Nanjing Medical University from January 2019 to June 2022 were selected. According to the infarct side of the posterior cerebellar infarction, they were divided into the left cerebellar infarction group (n=49) and the right cerebellar infarction group (n=46) . In the same period, 52 volunteers in the community were recruited as the control group. The general data, Montreal Cognitive Assessment Scale (MoCA) score and its various dimension scores (execution score, memory score, attention score, language score, visuospatial score, orientationg score) , Boston Naming Test (BNT) scores, Rey Auditory Verbal Learning Test (RAVLT) scores and Trail Making Test (TMT) results were compared among the three groups. Results MoCA score, attention score and visuospatial score of the control group were higher than those in left cerebellar infarction group and right cerebellar infarction group, execution score, memory score and language score were higher than those of the right cerebellar infarction group (P < 0.05) . execution score and language score of the left cerebellar infarction group were higher than those of the right cerebellar infarction group (P < 0.05) . The BNT score and RAVLT score of the control group were higher than those of the right cerebellar infarction group, and the TMT-A completion time and TMT-B completion time were shorter than those of the left cerebellar infarction group and the right cerebellar infarction group (P < 0.05) . The BNT score of the left cerebellar infarction group was higher than that of the right cerebellar infarction group, and the TMT-B completion time was shorter than that of the right cerebellar infarction group (P < 0.05) . Conclusion VCI after posterier cerebellar infarction has a certain degree of laterality. Patients with VCI after left posterior cerebellar infarction mainly exhibit a decrease in attention and visual spatial function, while patients with VCI after right posterior cerebellar infarction exhibit a more comprehensive decline in cognitive function, especially with more significant language and executive dysfunction.

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