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目的分析脑梗死患者急性期嗅觉功能与认知功能的关系,探讨临床简易嗅觉定量测试法在脑梗死患者认知障碍筛查中的应用价值。方法选取2010年10月到2011年1月我院神经内科住院诊断为脑梗死且入院后病情无继续加重,具备嗅觉查体结果及神经心理学测试结果的患者41例为病例组,同期在岗的医护人员、在读的硕士或博士研究生及进修医生、住院患者的健康家属中自愿接受嗅觉及神经心理学测试的41例为对照组。全部入组者均具备标准的蒙特利尔认知评估量表(MoCA)检测结果;均接受临床嗅觉查体。查体采用参照临床神经病学检查法及标准的嗅觉心理物理测试法而自行设计的简易嗅觉定量测试法。所得数据应用SPSS 17.0程序软件包进行统计学分析。结果 (1)符合入组标准者82例,病例组41例,男14例,女27例;对照组41例,男12例,女29例,两组的性别分布差异无统计学意义(P>0.05)。平均年龄病例组(58.20±9.29)岁,对照组(53.46±8.82)岁,两组年龄差异有统计学意义(P<0.05)。将两组年龄分别划分为40~49岁、50~59岁、60~69岁、70~79岁后,两组的年龄段分布情况比较差异无统计学意义(P>0.05)。(2)病例组全部头MRI结果均报告为腔隙性脑梗死,病灶单发或多发,部分伴有陈旧性病灶。(3)六种不同的气味下病例组及对照组左右侧鼻孔嗅觉功能比较无差异(P>0.05)。(4)两组MoCA得分有差异(P<0.05),对照组MoCA分值高于研究组。(5)病例组嗅觉识别阈值与MoCA得分存在负相关(r=-0.350,P<0.05),即嗅觉识别阈值越高者MoCA得分越低;对照组嗅觉识别阈值与MoCA得分无相关性(P>0.05)。(6)病例组MoCA值与年龄无相关(P>0.05);对照组MoCA值与年龄呈负相关(r=-0.342,P<0.05),即随着年龄的增长MoCA值降低;将全部入组者合并观察其MoCA值与年龄存在负相关(r=-0.309,P<0.05)。(7)两组嗅觉识别阈与年龄呈正相关性(病例组r=0.563,P<0.05;对照组r=0.541,P<0.05),即随年龄的增加嗅阈增高;将全部入组者合并观察,其嗅觉识别阈与年龄亦存在正相关(r=0.578,P<0.05)。结论脑梗死患者即使头MRI仅显示腔隙性梗死其认知功能较正常人亦差。无论是脑梗死患者还是正常人,随着认知功能的减退嗅觉功能减退;随着年龄的增长,嗅觉功能及认知功能均有所下降。我们的简易嗅觉定量测试法具有有效性和可行性。
Objective To analyze the relationship between olfactory function and cognitive function in patients with acute cerebral infarction and to explore the value of clinical simple olfactory quantitative test in screening cognitive impairment in patients with cerebral infarction. Methods From October 2010 to January 2011, 41 cases of patients with cerebral infarction admitted to Department of Neurology, Hospital of Neurology and without any further aggravating condition after hospitalization, olfactory check-up results and neuropsychological test results were included in the study. 41 medical and nursing staff who volunteered to be olfactory and neuropsychological tests among the master’s or doctoral students and further study doctors and in-patients’ health relatives were the control group. All participants had the standard Montreal Cognitive Assessment Scale (MoCA) test results; all accepted clinical olfactory examination. Physical examination with reference to clinical neurological examination method and standard olfactory psychophysical test method and simple self-designed olfactory quantitative test. The data obtained were statistically analyzed using the SPSS 17.0 program package. Results (1) 82 cases met the inclusion criteria, 41 cases were cases, 14 males and 27 females; control group, 41 cases, 12 males and 29 females. There was no significant difference in gender distribution between the two groups (P > 0.05). The mean age of the patients was 58.20 ± 9.29 years and that of the control group was 53.46 ± 8.82 years, with significant difference between the two groups (P <0.05). The two groups were divided into 40 to 49 years old, 50 to 59 years old, 60 to 69 years old, 70 to 79 years old, the age distribution of the two groups showed no significant difference (P> 0.05). (2) All cases of head MRI results were reported as lacunar infarction, single or multiple lesions, some with old lesions. (3) No significant difference was found in the olfactory function between left and right nostrils in six different scents and in control group (P> 0.05). (4) MoCA scores were significantly different between the two groups (P <0.05), and MoCA score of the control group was higher than that of the study group. (5) There was a negative correlation between the threshold value of olfactory recognition and MoCA score (r = -0.350, P <0.05), that is, the higher the olfactory recognition threshold, the lower the MoCA score; the control group had no correlation with MoCA score > 0.05). (6) There was no correlation between MoCA and age in the case group (P> 0.05). The MoCA value in the control group was negatively correlated with age (r = -0.342, P <0.05) There was a negative correlation between MoCA and age in the cohort (r = -0.309, P <0.05). (7) There was a positive correlation between the olfactory recognition threshold and age in the two groups (r = 0.563, r = 0.541, P <0.05 for the case group), ie, olfactory threshold increased with age; Observation, the olfactory recognition threshold and age there is also a positive correlation (r = 0.578, P <0.05). Conclusion Patients with cerebral infarction have worse cognitive function than normal subjects even though head MRI only shows lacunar infarction. Both patients with cerebral infarction or normal, with the decline of cognitive dysfunction, sense of smell; with age, the olfactory function and cognitive function decreased. Our simple olfactory quantitative test method is effective and feasible.