CAJ | 학술논문

目的比较4种皮质下单灶性卒中患者的认知损害的特点,了解丘脑和基底节的认知功能,为早期识别血管性认知功能损害(VCI)患者提供依据.方法使用成套的神经心理测验评估63例皮质下单灶卒中患者和34名健康对照组,病例组患者分为左丘脑卒中组(14例)、左基底节卒中组(17例)、右丘脑卒中组(15例)和右基底节卒中组(17例)4个组进行比较,5个组别的年龄、性别、教育程度比较差异无统计学意义.结果 (1)在记忆、注意/执行功能、语言能力、空间功能等存在广泛的认知功能损害,病例组明显差于对照组(P<0.05).(2)与其他3个卒中组相比,左侧丘脑卒中组在言语功能(BNT:16.6分±2.6分)、听觉即刻回忆(12.8个±4.4个)、听觉长延迟记忆回忆(2.4个±2.3个)、听觉再认(19.1个±3.1个)、结构延迟记忆(9.1分±4.7分)、SDMT偶然记忆(0.9分±1.1分)方面都比较差,左丘脑的损害对认知功能影响最严重(P<0.05).(3)左基底节组患者在与右手操作相关的项目(TMT-A耗时数75 8±22 s、TMT-B耗时数204 s±81 s、CIY123.5分±4.6分、SDMT24个±9个)表现优于另外3个卒中组,而接近健康对照组(P<0.05).结论卒中后认知功能可能存在一般的、非选择性的认知功能损害,同时,不同部位卒中所致认知损害各有特点,其中左丘脑卒中相对最为严重,而左基底节卒中后右手的功能训练有助于改善操作相关的心理测验的表现.
목적 비교4충피질하단조성졸중환자적인지손해적특점,료해구뇌화기저절적인지공능,위조기식별혈관성인지공능손해(VCI)환자제공의거.방법 사용성투적신경심리측험평고63례피질하단조졸중환자화34명건강대조조,병례조환자분위좌구뇌졸중조(14례)、좌기저절졸중조(17례)、우구뇌졸중조(15례)화우기저절졸중조(17례)4개조진행비교,5개조별적년령、성별、교육정도비교차이무통계학의의.결과 (1)재기억、주의/집행공능、어언능력、공간공능등존재엄범적인지공능손해,병례조명현차우대조조(P<0.05).(2)여기타3개졸중조상비,좌측구뇌졸중조재언어공능(BNT:16.6분±2.6분)、은각즉각회억(12.8개±4.4개)、은각장연지기억회억(2.4개±2.3개)、은각재인(19.1개±3.1개)、결구연지기억(9.1분±4.7분)、SDMT우연기억(0.9분±1.1분)방면도비교차,좌구뇌적손해대인지공능영향최엄중(P<0.05).(3)좌기저절조환자재여우수조작상관적항목(TMT-A모시수75 8±22 s、TMT-B모시수204 s±81 s、CIY123.5분±4.6분、SDMT24개±9개)표현우우령외3개졸중조,이접근건강대조조(P<0.05).결론 졸중후인지공능가능존재일반적、비선택성적인지공능손해,동시,불동부위졸중소치인지손해각유특점,기중좌구뇌졸중상대최위엄중,이좌기저절졸중후우수적공능훈련유조우개선조작상관적심리측험적표현.
Objective Comparing the characteristics of cognitive impairment of patients with single subcortical lesion stroke of four different areas,we are to explore the cognitive function of the thalamus and basal ganglia and this is help for early identification of vascular cognitive impairment(VCI).Methods 63 patients with single subcortical lesion stroke(including 14 left thalamic stoke group,17 left basal ganglia stroke group,15 right thalamic stroke group,17 right basal ganglia stroke group)and 34 healthy subjects participated in the current study,whose age,sex and education were matched.A comprehensive neuropsychological battery was used for evaluation.Results Compared to the normal control group,there was an overall decline of cognitive functions in patients with single subcortical lesion stroke in memory,attention/executive function,language,and visuospatial ability(P<0.05).The scores of the left thalamic stroke group were worse than the other three stroke groups in language(BNT16.6±2.6),auditory verbal learning test-immediate recall(12.8±4.4),auditory verbal learning test-delayed recall(2.4±2.3),listening recognition(19.1±3.1),structure delayed recall(9.1±4.7)and symbol digit modalities testrecall(0.9±1.1)(P<0.05).However,the left basal ganglia stroke group did better in tests manipulated by the right hand[including Trial making test(part A)score(75±22),Trail making test(part B)score (204±81),Clock drawing test(23.5±4.6),Symbol digit modalities test(24±9)]than other three stroke group,as good as the normal group(P<0.05).Conclusions Single subcoaical stroke patients may have general,non-selective cognitive impairment.But,different stroke areas have their own characteristics.The scores of the left thalamic stroke group were worse than the other three stroke groups.