摘要目的 探讨不同亚型轻度认知功能损害(MCI)患者的神经心理学特征.方法 采用多种神经心理学量表对28例遗忘型MCI (aMCI)、21例血管型MCI (V-MCI)、21例帕金森病型MCI(PD-MCI)及46名健康老年人进行评定,比较不同亚型MCI的神经心理学特征.结果 (1)与健康对照组比较,各亚型MCI组在总体认知评分及剑桥老年认知检查量表中文版(CAMCOG-C)子项评分差异均有统计学意义.aMCI组在定向、语言表达、近记忆、学习记忆、注意、计算、思维及知觉方面均受损,差异具有统计学意义(t=4.580、5.150、3.053、4.070、5.918、2.121、2.952、3.175,均P＜0.05)；语言理解、远记忆与执行能力相对保留,差异无统计学意义.V-MCI组定向、语言表达、注意与执行功能受损(t=2.974、3.165、4.216、3.197,均P＜0.05),记忆力、计算、思维及知觉较对照组差异无统计学意义.PD-MCI组在语言表达、近记忆、远记忆、学习记忆、注意及执行功能方面损害均显著,差异具有统计学意义(t=4.433、3.065、3.821、3.447、5.344、0.348,均P＜0.05).(2)各亚型MCI组间比较:与V-MCI组[(3.52±0.87)分、(12.48±1.83)分]相比,aMCI组[(3.07±0.81)分、(11.07±2.28)分]与PD-MCI组[(3.00 ±0.89)分、(11.33 ±1.91)分]在CAMCOG-C总体评分及其子项中记忆能力包括近记忆、学习记忆降低显著,差异具有统计学意义(aMCI与V-MCI比较t=1.868、2.381,PD-MCI与V-MCI比较t=1.921、1.980；均P＜0.05).PD-MCI组中,远记忆及执行功能较其他两组显著降低,差异具有统计学意义(与aMCI比较t=2.498、4.257,与V-MCI比较t=1.684、1.492:均P＜0.05).(3)aMCI组GDS评分较健康对照组显著增高,差异具有统计学意义(t=2.850,P＜0.05),而V-MCI组及PD-MCI组与健康对照组比较差异均无统计学意义,但aMCI组及V-MCI组GDS得分较PD-MCI组增高.结论 3种不同亚型MCI认知损害均为多区域性,aMCI主要表现为记忆损害,V-MCI以执行功能损害为主,PD-MCI记忆及执行功能均受损；aMCI较其他亚型更易出现抑郁倾向.不同亚型MCI神经心理学特征的不同,反映了不同的病理生理学机制.

abstractsObjective To investigate the neuropsychological features of different mild cognitive impairment (MCI) subtypes.Methods A neuropsychology battery was applied in this study.Seventy MCI participants were enrolled in the test and classified as:28 amnestic MCI ( aMCI),21 vascular MCI ( V-MCI),and 21 Parkinson' s disease MCI (PD-MCI).Forty six normal old people were also evaluated as control.Results First,there were significant differences in the CAMCOG-C and CAMCOG-C subscales of each MCI subtype compared with the normal control. aMCI patients showed significantly impaired orientation,language expression,recent memory,attention,calculation,abstraction and perception (t =4.580,5.150,3.053,4.070,5.918,2.121,2.952,3.175 ; all P ＜ 0.05).However,the ability of language comprehension,remote memory and execution were relatively reserved.V-MCI patients scored lower in the cognitive function of orientation,language expression,attention and execution compared with the normal control(t =2.974,3.165,4.216,3.197; all P ＜ 0.05),with no significant difference in memory,calculation,abstraction and perception.A boarder cognitive impairment was observed in PD-MCI patients who showed significantly impaired language expression,recent memory,remote memory,learning memory,attention and execution(t =4.433,3.065,3.821,3.447,5.344,0.348 ; all P ＜ 0.05).Second,aMCI (3.07 ± 0.81,11.07 ± 2.28 ) and PD-MCI (3.00 ± 0.89,11.33 ± 1.91 ) patients scored significantly lower in CAMCOG scores and CAMCOG subscales including recent memory and learning memory compared with V-MCI(3.52 ±0.87,12.48 ± 1.83;aMCI vs V-MCI:t =1.868,2.381,PD-MCI vs V-MCI:t =1.921,1.980 ; all P ＜ 0.05 ).The remote memory and execution function in PD-MCI were significantly impaired compared to the other two subtypes(PD-MCI vs aMCI:t =2.498,4.257; PD-MCI vs V-MCI:t =1.684,1.492 ;all P ＜ 0.05 ).Third,the GDS scores were different among the four groups. aMCI grouphad significant higher GDS score compared to the normal control group( t =2.850,P ＜ 0.05 ),while there were no similar changes in V-MCI and PD-MCI groups.Comparing different MCI subtypes with each other,aMCI and V-MCI groups had higher GDS scores than PD-MCI group.Conclusions The features of cognitive impairment in the 3 subtypes are all multiple domains.The characteristic impairment domains are memory in aMCI,executive function in V-MCI,and both memory and executive functions in PD-MCI.aMCI may show greater depression tendency compared to the other two subtypes.The different features in the subtypes of MCI may represent different pathophysiololgical changes in each MCI subtype.