CAJ | 학술논문

目的随访经丘脑底核脑深部电刺激(DBS)临床治疗的帕金森病患者,观察丘脑底核DBS术对其认知功能的影响.方法应用统一帕金森病评定量表第二、三部分(UPDRSⅡ,Ⅲ),改良Hoehn-Yahr (H-Y)分级,系列神经心理学量表简易智能量表(MMSE)、韦氏记忆量表(WMS)、Nissen软件(SRTT)、残图命名、词语流畅性(VF)和画钟测验等方法,分别于丘脑底核DBS术前1周及术后12个月对20例帕金森病患者的临床特征和认知功能进行评估.以20名与之匹配的健康人作为健康对照.结果帕金森病患者DBS术后无论“开期”还是“关期”日常生活能力(UPDRSⅡ)、运动功能(UPDRSⅢ)、病情(H-Y分级)较术前均有显著的改善(P＜0.01).术前帕金森病患者记忆商为88.10±16.70,明显低于对照组(100.90±6.45;t=-3.187,P＜0.01).帕金森病患者DBS手术前后的记忆商及各项分测验比较差异均无统计学意义.SRTT测试获得的平均反应时(Tavg)对照组、术前帕金森病组及术后帕金森病组分别为(1.09±0.32)、(1.58 ±0.83)、(1.62±0.83)s,术前帕金森病组较对照组延长(t =2.432,P＜0.05);对3个组组内各小节间比较发现,帕金森病患者手术前后各节Tavg差异均无统计学意义;对错误率比较,对照组、术前帕金森病组及术后帕金森病组的总错误率分别为4.84％±4.27％、9.76％±1.52％和13.41％±1.11％.MMSE和残图命名测验结果显示,对照组、术前帕金森病组和术后帕金森病组3组间差异均无统计学意义;对于VF测验结果,对照组和术前帕金森病组比较差异有统计学意义(Z=-2.927,P＜0.01),术后VF较术前下降差异有统计学意义(Z=-2.469,P=0.014);对于画钟测验结果,对照组和术前帕金森病组比较差异有统计学意义(Z=-2.762,P＜0.01),术后较术前有所提升(Z=-2.165,P=0.03).结论丘脑底核DBS术在一定程度上可以引起帕金森病患者认知功能的改变:VF下降,视空间功能和注意力改善,可能内隐记忆和执行功能下降等. 目的隨訪經丘腦底覈腦深部電刺激(DBS)臨床治療的帕金森病患者,觀察丘腦底覈DBS術對其認知功能的影響.方法應用統一帕金森病評定量錶第二、三部分(UPDRSⅡ,Ⅲ),改良Hoehn-Yahr (H-Y)分級,繫列神經心理學量錶簡易智能量錶(MMSE)、韋氏記憶量錶(WMS)、Nissen軟件(SRTT)、殘圖命名、詞語流暢性(VF)和畫鐘測驗等方法,分彆于丘腦底覈DBS術前1週及術後12箇月對20例帕金森病患者的臨床特徵和認知功能進行評估.以20名與之匹配的健康人作為健康對照.結果帕金森病患者DBS術後無論“開期”還是“關期”日常生活能力(UPDRSⅡ)、運動功能(UPDRSⅢ)、病情(H-Y分級)較術前均有顯著的改善(P＜0.01).術前帕金森病患者記憶商為88.10±16.70,明顯低于對照組(100.90±6.45;t=-3.187,P＜0.01).帕金森病患者DBS手術前後的記憶商及各項分測驗比較差異均無統計學意義.SRTT測試穫得的平均反應時(Tavg)對照組、術前帕金森病組及術後帕金森病組分彆為(1.09±0.32)、(1.58 ±0.83)、(1.62±0.83)s,術前帕金森病組較對照組延長(t =2.432,P＜0.05);對3箇組組內各小節間比較髮現,帕金森病患者手術前後各節Tavg差異均無統計學意義;對錯誤率比較,對照組、術前帕金森病組及術後帕金森病組的總錯誤率分彆為4.84％±4.27％、9.76％±1.52％和13.41％±1.11％.MMSE和殘圖命名測驗結果顯示,對照組、術前帕金森病組和術後帕金森病組3組間差異均無統計學意義;對于VF測驗結果,對照組和術前帕金森病組比較差異有統計學意義(Z=-2.927,P＜0.01),術後VF較術前下降差異有統計學意義(Z=-2.469,P=0.014);對于畫鐘測驗結果,對照組和術前帕金森病組比較差異有統計學意義(Z=-2.762,P＜0.01),術後較術前有所提升(Z=-2.165,P=0.03).結論丘腦底覈DBS術在一定程度上可以引起帕金森病患者認知功能的改變:VF下降,視空間功能和註意力改善,可能內隱記憶和執行功能下降等.
목적 수방경구뇌저핵뇌심부전자격(DBS)림상치료적파금삼병환자,관찰구뇌저핵DBS술대기인지공능적영향.방법 응용통일파금삼병평정량표제이、삼부분(UPDRSⅡ,Ⅲ),개량Hoehn-Yahr (H-Y)분급,계렬신경심이학량표간역지능량표(MMSE)、위씨기억량표(WMS)、Nissen연건(SRTT)、잔도명명、사어류창성(VF)화화종측험등방법,분별우구뇌저핵DBS술전1주급술후12개월대20례파금삼병환자적림상특정화인지공능진행평고.이20명여지필배적건강인작위건강대조.결과 파금삼병환자DBS술후무론“개기”환시“관기”일상생활능력(UPDRSⅡ)、운동공능(UPDRSⅢ)、병정(H-Y분급)교술전균유현저적개선(P＜0.01).술전파금삼병환자기억상위88.10±16.70,명현저우대조조(100.90±6.45;t=-3.187,P＜0.01).파금삼병환자DBS수술전후적기억상급각항분측험비교차이균무통계학의의.SRTT측시획득적평균반응시(Tavg)대조조、술전파금삼병조급술후파금삼병조분별위(1.09±0.32)、(1.58 ±0.83)、(1.62±0.83)s,술전파금삼병조교대조조연장(t =2.432,P＜0.05);대3개조조내각소절간비교발현,파금삼병환자수술전후각절Tavg차이균무통계학의의;대착오솔비교,대조조、술전파금삼병조급술후파금삼병조적총착오솔분별위4.84％±4.27％、9.76％±1.52％화13.41％±1.11％.MMSE화잔도명명측험결과현시,대조조、술전파금삼병조화술후파금삼병조3조간차이균무통계학의의;대우VF측험결과,대조조화술전파금삼병조비교차이유통계학의의(Z=-2.927,P＜0.01),술후VF교술전하강차이유통계학의의(Z=-2.469,P=0.014);대우화종측험결과,대조조화술전파금삼병조비교차이유통계학의의(Z=-2.762,P＜0.01),술후교술전유소제승(Z=-2.165,P=0.03).결론 구뇌저핵DBS술재일정정도상가이인기파금삼병환자인지공능적개변:VF하강,시공간공능화주의력개선,가능내은기억화집행공능하강등.
Objeetive To follow up the patients with Parkinson's disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS) therapy,and to compare the changes of cognitive function before and after this functional surgery.Methods The authors set up a series of clinical tests including unified Parkinson's disease rating scale (UPDRS) Ⅱ & Ⅲ,Hoehn & Yahr stage (H-Y stage),mini mental state examination (MMSE),Wechsler memory scale (WMS),serial reaction time task (SRTT),degraded picture naming (DPN),verbal fluency (VF),clock drawing test (CDT) to measure the performance of both clinical characteristics and cognitions 1 week before and 12 months after STN-DBS operation in 20 PD patients,matched with 20 healthy adults who just assessed by the neuropsychological tests.Results Activity of daily life (UPDRS Ⅱ),motor manifestations (UPDRS Ⅲ) and disease condition (H-Y stage) were all significantly improved whether they were "on period" or "off period" (P ＜ 0.01).In the test of WMS,the memory quotient (MQ) scores of PD patients (88.10 ± 16.70) were significantly lower (t =-3.187,P ＜0.01) than the control group (100.90 ± 6.45).By SRTT test,the mean average response time (Tavg) of the control group,pre-operation and post-operation groups was (1.09 ± 0.32) s,(1.58 ± 0.83) s and (1.62 ± 0.83) s,respectively.As to the comparison of the blocks,no changes were found within each group of PD (pro-F =0.329,P =0.964 ; post-F =0.377,P =0.945),by contrast,it had been proved to be statistically significant in the control group (F =2.316,P ＜0.05).The mean error rates of the control group,pre-operation and post-operation groups were 4.84％ ± 4.27％,9.76％ ± 1.52％ and 13.41％ ± 1.11％ respectively,and the control group was not different from pre-operation group (t =1.388,P =0.173) while significantly different compared with post-operation group (t =3.225,P ＜0.01).As for MMSE and DPN results,no significant benefits were obtained in the control,pre-operation and post-operation groups.In regard to VF,there was a statistically significant difference between control group and pre-operation group (Z =-2.927,P ＜ 0.01),and it was significantly worse after surgery (Z =-2.469,P =0.014).As for CDT,significant benefits were obtained in both preoperation (Z =-2.762,P ＜ 0.01) and post-operation groups (Z =-2.165,P =0.03) compared with control group.Conelusions To some extent,STN-DBS can affect the cognition of PD patients,such as lowing VF,improving visual-spatial function and attention,a decreasing trend of implicit memory and executive function.Explicit memory is partly dissociated with implicit memory.文章序号>=10.3760/cma.j.issn.1006-7876.2014.09.005