中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
9期
603-609
,共7页
戴淑娟%艾青龙%马碧%廖敏%王文敏
戴淑娟%艾青龍%馬碧%廖敏%王文敏
대숙연%애청룡%마벽%료민%왕문민
脑梗死%神经心理学测验%磁共振成像
腦梗死%神經心理學測驗%磁共振成像
뇌경사%신경심이학측험%자공진성상
Brain infarction%Neuropsychological tests%Magnetic resonance imaging
目的 探讨小脑梗死患者的神经心理学和功能影像学的特点.方法 对59例小脑梗死患者(左侧小脑梗死患者27例,右侧小脑梗死患者32例)和26名健康对照者进行神经心理学和功能影像学评估,采用独立样本t检验方法分析认知功能改变及其与功能影像学改变的关系.结果 (1)与健康对照组相比,小脑梗死患者(左侧/右侧)在记忆、视空间能力和执行功能有关测验中得分(分)较低,其中记忆测试中的听觉词汇学习测试[12.27±1.37与9.33±1.90(左侧)/10.25±2.20(右侧);t =6.46、4.26]、临床记忆量表中的联想学习[22.77±3.07与18.67±1.98(左侧)/16.84±3.55(右侧),t=5.74、6.69]、视空间测试中的符号数字模式测试[42.54±6.32与20.85±9.57(左侧)/34.84±16.10(右侧),t=9.68、2.47]、执行功能测试中的威斯康星卡片分类测试子项目错误应答数[16.77±2.64与52.22±16.29(左侧)/54.47±16.27(右侧),t=11.15、12.89]得分均低于健康对照组,差异均具有统计学意义(均P ＜0.05).(2)左侧小脑梗死患者与健康对照组相比,正确应答百分比分值(分)较低(58.71±10.93与78.43±5.26,t=-8.41),差异具有统计学意义(P＜0.05),完成第一个分类所需应答数分值(分)较高(23.59 ±9.79与14.12±3.75,=4.68),差异具有统计学意义(P＜0.05),提示抽象概括能力和概念形成能力受损;右侧小脑梗死患者与对照组相比,总记忆商分值(分)较低(86.69±7.56与112.02±9.70,t=-11.17),差异有统计学意义(P＜0.05),持续性应答数分值(分)较高(44.59±17.50与8.23±3.46,t=11.47),差异有统计学意义(P＜0.05),非持续性错误分值(分)较高(44.00±20.67与10.58±2.35,t =9.07),差异有统计学意义(P＜0.05),提示记忆力、认知转换和注意力受损.(3)与健康对照组比较,小脑梗死患者的小脑与前额叶和顶叶的纤维联系减少.结论 小脑通过与大脑的连接,参与了部分认知功能(如记忆、视空间和执行功能等)形成的过程.小脑梗死后其与前额叶和顶叶纤维的联系减少是认知功能损伤的可能机制.
目的 探討小腦梗死患者的神經心理學和功能影像學的特點.方法 對59例小腦梗死患者(左側小腦梗死患者27例,右側小腦梗死患者32例)和26名健康對照者進行神經心理學和功能影像學評估,採用獨立樣本t檢驗方法分析認知功能改變及其與功能影像學改變的關繫.結果 (1)與健康對照組相比,小腦梗死患者(左側/右側)在記憶、視空間能力和執行功能有關測驗中得分(分)較低,其中記憶測試中的聽覺詞彙學習測試[12.27±1.37與9.33±1.90(左側)/10.25±2.20(右側);t =6.46、4.26]、臨床記憶量錶中的聯想學習[22.77±3.07與18.67±1.98(左側)/16.84±3.55(右側),t=5.74、6.69]、視空間測試中的符號數字模式測試[42.54±6.32與20.85±9.57(左側)/34.84±16.10(右側),t=9.68、2.47]、執行功能測試中的威斯康星卡片分類測試子項目錯誤應答數[16.77±2.64與52.22±16.29(左側)/54.47±16.27(右側),t=11.15、12.89]得分均低于健康對照組,差異均具有統計學意義(均P ＜0.05).(2)左側小腦梗死患者與健康對照組相比,正確應答百分比分值(分)較低(58.71±10.93與78.43±5.26,t=-8.41),差異具有統計學意義(P＜0.05),完成第一箇分類所需應答數分值(分)較高(23.59 ±9.79與14.12±3.75,=4.68),差異具有統計學意義(P＜0.05),提示抽象概括能力和概唸形成能力受損;右側小腦梗死患者與對照組相比,總記憶商分值(分)較低(86.69±7.56與112.02±9.70,t=-11.17),差異有統計學意義(P＜0.05),持續性應答數分值(分)較高(44.59±17.50與8.23±3.46,t=11.47),差異有統計學意義(P＜0.05),非持續性錯誤分值(分)較高(44.00±20.67與10.58±2.35,t =9.07),差異有統計學意義(P＜0.05),提示記憶力、認知轉換和註意力受損.(3)與健康對照組比較,小腦梗死患者的小腦與前額葉和頂葉的纖維聯繫減少.結論 小腦通過與大腦的連接,參與瞭部分認知功能(如記憶、視空間和執行功能等)形成的過程.小腦梗死後其與前額葉和頂葉纖維的聯繫減少是認知功能損傷的可能機製.
목적 탐토소뇌경사환자적신경심이학화공능영상학적특점.방법 대59례소뇌경사환자(좌측소뇌경사환자27례,우측소뇌경사환자32례)화26명건강대조자진행신경심이학화공능영상학평고,채용독립양본t검험방법분석인지공능개변급기여공능영상학개변적관계.결과 (1)여건강대조조상비,소뇌경사환자(좌측/우측)재기억、시공간능력화집행공능유관측험중득분(분)교저,기중기억측시중적은각사회학습측시[12.27±1.37여9.33±1.90(좌측)/10.25±2.20(우측);t =6.46、4.26]、림상기억량표중적련상학습[22.77±3.07여18.67±1.98(좌측)/16.84±3.55(우측),t=5.74、6.69]、시공간측시중적부호수자모식측시[42.54±6.32여20.85±9.57(좌측)/34.84±16.10(우측),t=9.68、2.47]、집행공능측시중적위사강성잡편분류측시자항목착오응답수[16.77±2.64여52.22±16.29(좌측)/54.47±16.27(우측),t=11.15、12.89]득분균저우건강대조조,차이균구유통계학의의(균P ＜0.05).(2)좌측소뇌경사환자여건강대조조상비,정학응답백분비분치(분)교저(58.71±10.93여78.43±5.26,t=-8.41),차이구유통계학의의(P＜0.05),완성제일개분류소수응답수분치(분)교고(23.59 ±9.79여14.12±3.75,=4.68),차이구유통계학의의(P＜0.05),제시추상개괄능력화개념형성능력수손;우측소뇌경사환자여대조조상비,총기억상분치(분)교저(86.69±7.56여112.02±9.70,t=-11.17),차이유통계학의의(P＜0.05),지속성응답수분치(분)교고(44.59±17.50여8.23±3.46,t=11.47),차이유통계학의의(P＜0.05),비지속성착오분치(분)교고(44.00±20.67여10.58±2.35,t =9.07),차이유통계학의의(P＜0.05),제시기억력、인지전환화주의력수손.(3)여건강대조조비교,소뇌경사환자적소뇌여전액협화정협적섬유련계감소.결론 소뇌통과여대뇌적련접,삼여료부분인지공능(여기억、시공간화집행공능등)형성적과정.소뇌경사후기여전액협화정협섬유적련계감소시인지공능손상적가능궤제.
Objective To investigate the neuropsychological and functional neuroimaging features in patients with cerebellar infarction (CI).Methods We analyzed 59 CI patients (27 left CI,32 right CI) and 26 healthy control subjects who received standard and experimental cognitive testing and neuroimaging study.We compared the cognitive manifestations between the groups with Student' s t test.Results Patients with CI(left/right) achieved significantly lower scores in auditory verbal learning test (AVLT) of memory test (12.27 ± 1.37 vs 9.33 ± 1.90/10.25 ±2.20,t =6.46,4.26,P ＜0.05),Associative Learning of Clinical Memory Scale (22.77 ± 3.07 vs 18.67 ± 1.98/16.84 ± 3.55,t =5.74,6.69,P ＜ 0.05),symbol digit modalities test (SDMT) of visuospatial test(42.54 ±6.32 vs 20.85 ±9.57/34.84 ± 16.10,t =9.68,2.47,P ＜ 0.05),and errors responses (RE) of Wisconsin card sorting test for executive function (16.77 ± 2.64vs 52.22 ± 16.29/54.47 ± 16.27,t =11.15,12.89,P ＜ 0.05).Patients with left CI had significantly lower scores in correct responses percentage (RCP; 58.71 ± 10.93 vs 78.43 ± 5.26,t =-8.41,P ＜ 0.05)and significantly higher scores in the trials to compete first category (RF; 23.59 ± 9.79 vs 14.12 ± 3.75,t =4.68,P ＜ 0.05).Those finding suggests left CI would cause impairment on abstract conceptualization and concept formation; The patients with right CI had significantly lower scores in total memory quotient (86.69 ± 7.56 vs 112.02 ± 9.70,t =-11.17,P ＜ 0.05),higher scores in perseverative responses (RP ;44.59 ± 17.50 vs 8.23 ± 3.46,t =11.47,P ＜ 0.05) and nonperseverative responses errors percentage (nRPE; 44.00 ±20.67 vs 10.58 ± 2.35,t =9.07,P ＜ 0.05).It means right CI would cause serious deficits on memory,cognitive shift and attention.The fibers between cerebellum and frontal,parietal lobe were reduced in CI patients,compared with healthy control.Conclusions These results suggest that cerebellum participated in the formation of part of cognitive function by connection with cerebrum.After CI,that the fibers contacted with the prefrontal and parietal reduced is the possible mechanisms for cognitive impairment.
