CAJ | 학술논문

目的对1例以汉语为文化背景的语义性痴呆(Semantic Dementia,SD)患者的书写障碍特点进行分析并探讨其机制.方法采用汉语失写检查法(Chinese agraphia battery,CAB)、汉语失语成套测验( Aphasia Battery of Chinese,ABC)中的书写部分及其他神经心理学测试检查1例SD患者.结果 (1)韦氏成人智力量表中知识、词汇定义分测验得分分别为6/29及8/80;范畴流畅性测试1min内说出11个(划界分为≥25分)；语义特征测试为37/60(其中类别8/20、功能7/20、自然特征8/20)；(2)书写损害程度由重到轻依次为看图书写(6/40)、主动书写(1/10)、听写(11/40)、系列书写(35/40)；抄写相对保留(40/40)；书写障碍表现为失语性失写,均有明显的构字障碍,字词错写和语法障碍；(3)MMSE得分20/30,Mo-CA得分19/30.其中执行功能损害明显,近事记忆相对保留.结论以汉语为文化背景的SD患者一般知识的储存丧失,词义理解差,其书写障碍表现为失语性失写,且书写错误类型及其分布与西方存在显著差异,推测差异源于汉字为象形会意文字,理解的通路为“音-形-义”通路,而拼音文字的单词形态结构仅仅是符号,其理解通路为“音-义”通路.
목적 대1례이한어위문화배경적어의성치태(Semantic Dementia,SD)환자적서사장애특점진행분석병탐토기궤제.방법 채용한어실사검사법(Chinese agraphia battery,CAB)、한어실어성투측험( Aphasia Battery of Chinese,ABC)중적서사부분급기타신경심이학측시검사1례SD환자.결과 (1)위씨성인지역량표중지식、사회정의분측험득분분별위6/29급8/80;범주류창성측시1min내설출11개(화계분위≥25분)；어의특정측시위37/60(기중유별8/20、공능7/20、자연특정8/20)；(2)서사손해정도유중도경의차위간도서사(6/40)、주동서사(1/10)、은사(11/40)、계렬서사(35/40)；초사상대보류(40/40)；서사장애표현위실어성실사,균유명현적구자장애,자사착사화어법장애；(3)MMSE득분20/30,Mo-CA득분19/30.기중집행공능손해명현,근사기억상대보류.결론 이한어위문화배경적SD환자일반지식적저존상실,사의리해차,기서사장애표현위실어성실사,차서사착오류형급기분포여서방존재현저차이,추측차이원우한자위상형회의문자,리해적통로위“음-형-의”통로,이병음문자적단사형태결구부부시부호,기리해통로위“음-의”통로.
Objective To investigate the clinical features of Chinese dysgraphia and then probe into its mechanisms in a patient with semantic dementia(SD).Methods The patient with SD finished the writing part of the Aphasia Battery of Chinese (Aphasia Battery of Chinese,ABC) and the Chinese agraphia battery (Chinese agraphia battery,CAB ) in addition to a series of other neuropsychological tests.Results ( 1 ) On the Wechsler Adult intelligence scale,the patient performed poorly on information and vocabulary with scores of 6/29 and 8/80,respectively.He spoke out only 11 names totally on the category fluency test within 1 minute,while 25 names or more than were normal.Semantic features test showed he made 37 right answers of 60 questions,with scores of 8/20 on category,7/20 on function and 8/20 on nature features.(2)The writing disorder exhibited Chinese aphasia agraphia with obvious difficulty in forming characters,wrong characters of the same pronunciation or the same form or unrelated errors,and grammatical impairments.Its damage from serious to light occurred in picture writing( 6/40),writing sentences to convey meaning(1/10),dictation(11/40) and automatic writing(35/40).The transcription was relatively preserved (40/40 ). (3)He scored 20 and 19 points on MMSE and MoCA.Executive function was damaged significantly,while recent memory was preserved relatively.Conclusion The patient with SD shows an impoverished store of general knowledge and poor comprehension of single-word.The nature of SD's dysgraphia presents Chinese aphasia agraphia,undoubtedly due to progressive deterioration in semantic memory.More importantly,its error types and distribution show apparent discrepancy from that of alphabetic script.Presumably because Chinese writing system is logographic in nature and the pathway of comprehension concerning syllable-orthography-morphemes mapping,while alphabetic writing system follows a principle of mapping graphemes on-to phonemes and letters themselves dont stand for any meaning.