Relationship between concussion and neuropsychological performance in college football players.

CONTEXT: Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. OBJECTIVES: To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players. DESIGN, SETTING, AND PARTICIPANTS: A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10). MAIN OUTCOME MEASURES: Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion. RESULTS: Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate. CONCLUSIONS: Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.     

Head and neck injuries among ice hockey players wearing full face shields vs half face shields

CONTEXT: Speculation exists that use of a full face shield by ice hockey players may increase their risk of concussions and neck injuries, offsetting the benefits of protection from dental, facial, and ocular injuries, but, to our knowledge, no data exist regarding this possibility. OBJECTIVE: To determine the risk of sustaining a head or neck injury among intercollegiate ice hockey players wearing full face shields compared with those wearing half shields. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study conducted during the 1997-1998 Canadian Inter-University Athletics Union hockey season of 642 male hockey players (mean age, 22 years) from 22 teams. Athletes from 11 teams wore full face shields and athletes from 11 teams wore half face shields during play. MAIN OUTCOME MEASURE: Reportable injury, defined as any event requiring assessment or treatment by a team therapist or physician or any mild traumatic brain injury or brachial plexus stretch, categorized by time lost from subsequent participation and compared by type of face shield. RESULTS: Of 319 athletes who wore full face shields, 195 (61.6%) had at least 1 injury during the study season, whereas of 323 who wore half face shields, 204 (63.2 %) were injured. The risk of sustaining a facial laceration and dental injury was 2.31 (95% confidence interval [CI], 1.53-3.48; P<.001) and 9.90 (95% CI, 1.88-52.1; P = .007) times greater, respectively, for players wearing half vs full face shields. No statistically significant risk differences were found for neck injuries, concussion, or other injuries, although time lost from participation because of concussion was significantly greater in the half shield group (P<.001), than in the group wearing full shields. CONCLUSIONS: These data provide evidence that the use of full face shields is associated with significantly reduced risk of sustaining facial and dental injuries without an increase in the risk of neck injuries, concussions, or other injuries.     

Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study

Context  Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury. Objective  To estimate the incidence of concussion and time to recovery after concussion in collegiate football players. Design, Setting, and Participants  Prospective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain concussion occurrence. Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season. Main Outcome Measures  Incidence of concussion and repeat concusion; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons. Results  During follow-up of 4251 player-seasons, 184 players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. There was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with =" BORDER="0">3 previous concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous concussion). Of the 12 incident within-season repeat concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury. Conclusions  Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a concussion may have additional concussions in the same playing season; and previous concussions may be associated with slower recovery of neurological function.      

Sports concussion in the child and adolescent athlete

Sports concussions are common among children and adolescents, and recent evidence suggests that concussions are more serious injuries than previously thought. Young athletes appear to recover from concussion more slowly than older athletes. Recovery is prolonged if these athletes return to play or school prematurely, and reinjury increases their risk of more serious sequelae. These newer data on concussions have raised our appreciation of this injury and have informed the development of more conservative treatment guidelines for the child and adolescent athlete. The purpose of this JAMS article is to review the new evidence and the most recent management guidelines regarding sports concussion in the young athlete.     

Concussion in sports. Guidelines for the prevention of catastrophic outcome

Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.     

Diagnosis and management of sports-related concussion: a 15-year-old athlete with a concussion

Concussion in youth athletes is a growing problem worldwide. During the past decade, significant progress has been made in standardization of the assessment of young athletes, and a growing appreciation of metabolic vulnerability, activity, and cognitive challenges has led to guidelines and suggestions for rest from the field as well as cognitive rest from school. Outcome data have begun to establish groups linked to symptom class, genetics, and sex who are at risk of worse outcomes from concussions. Decisions regarding return to activity are now based on at-rest symptoms, graded increases in activity, and neuropsychological testing. Using the case of Ms X, a 15-year-old otherwise healthy high school student who fell while skiing, evaluation, prognosis, and management of concussion are discussed.     

Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study

Context  Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury. Objective  To prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion. Design, Setting, and Participants  Prospective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury. Main Outcome Measures  Scores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery. Results  No player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI}, 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, –0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, -1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, -0.03; 95% CI, -1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, -0.31; 95% CI, -3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion. Conclusions  Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.      

Return to athletic competition following concussion.

To establish guidelines for the examination of patients and the resumption of athletic activity after concussion, the injury is characterized as mild, moderate or severe (unconscious only transiently, for less than 5 minutes or for more than 5 minutes). The basic recommendation is that return to training and competition should be deferred until all associated symptoms such as headaches have completely resolved. The decision to return must take into account the nature of the sport, the athlete's level of participation and the cumulative effect of previous concussions. Some athletes will have to avoid any further participation in their sport.     

Concussion among under 20 rugby union players in Ireland: incidence, attitudes and knowledge

Introduction

The aim of this study was to determine the incidence of concussion among a cohort of male under 20 rugby players and assess basic knowledge and attitudes.

Methods

Under 20 age group, players were recruited from local clubs as well as the national academy system. Players were asked to report on their history of concussion as well as a number of factors regarding their recognition of symptoms and behaviours regarding the diagnosis of concussion.

Results

133 players responded (95 % response rate). Players could list a mean of 2.6 concussion related symptoms. 64 reported sustaining at least one concussion (average 2.25) and 36 sought medical attention following a concussion. 61 said that they would report suffering a concussion to their coach while 32 would report it to a ‘team physiotherapist’ or doctor. 114 believed that concussion is as serious as other rugby injuries and 100 believe that playing on while concussed could lead to long-term medical problems.

Conclusions

Further educational efforts are required in this age group of rugby union players to reduce the risk of unnecessary secondary injury. Coaches, managers and players alike need to be targeted in any educational program.     

Effects of prefabricated foot orthoses and soft insoles on postural stability in professional soccer players

Postural stability is an important component of skilled athletic activity. However, the effects of foot orthoses on stability have not been adequately addressed. This study measured postural sway in 30 asymptomatic professional soccer players in three standing positions and four underfoot conditions. The results revealed that the underfoot condition had no significant effect on sway in the mediolateral or anteroposterior planes; however, there was a trend toward less mediolateral sway when subjects stood in a unipedal position with prefabricated orthoses. These results suggest that insoles and foot orthoses have no significant beneficial or detrimental effects on postural stability in asymptomatic subjects. Clinically, this suggests that no improvements in balance performance could be expected with prophylactic use of insoles or orthoses but that clinicians may prescribe insoles and foot orthoses without fear of impairing postural performance in elite athletes.     

精神分裂症认知功能与儿茶酚氧位甲基转移酶基因多态性的关联研究

目的探讨儿茶酚氧位甲基转移酶(COMT)基因多态性与精神分裂症相关认知功能的关系。方法收集昆明地区符合CCMD-3的精神分裂症患者共128例,分别调查其一般资料和进行相关的认知功能测试,包括数字广度(顺,倒)、算术、数字符号、木块图形、连线测验A和B、逻辑记忆(瞬时,延迟)、视觉记忆(瞬时,延迟)和词汇流畅共8项认知功能测试;抽取患者静脉血;采用聚合酶链反应(PCR)和限制性片段长度多态性(RFLP)的方法,检测COMT基因多态性。分析各基因组与认知功能测试结果的关联性。结果三组基因型患者的数字广度(倒)分值比较差异有显著性(F=7.21,P<0.01),经两两比较,高活性基因型患者(4.7±1.5)分,与低活性基因型患者(6.7±2.8)分比较,差异有非常显著性(P<0.01),中等活性基因型(5.4±2.3)分,与低活性基因型比较差异有显著性(P<0.05),高活性组与中等活性组经比较差异无显著性(P>0.05)。其他认知功能测试与COMT基因多态性未显示相关关系。结论COMT基因多态性与数字广度(倒)相关联,提示COMT基因可能从分子水平通过前额叶皮质的多巴胺信号来影响精神分裂症患者的工作记忆。     

迷迭香干预三重脑震荡大鼠焦虑行为变化

目的 用迷迭香干预多重脑震荡 (multiple cerebral concussion, MCC) 大鼠, 观察其抗焦虑治疗作用.方法 用单摆打击装置复制大鼠三重脑震荡 (3MCC) 模型.将损伤大鼠随机分成迷迭香高、中、低3个剂量组、吐温溶剂组、3MCC组和正常对照组 (C组) .伤后连续给药16 d后, 进行旷场实验 (OFT) , 评估其焦虑样行为改变情况.结果 (1) 与正常组比较:各实验组在旷场中央区活动时间均减少, 在旷场周围区活动时间增加, 除高剂量组外, 其余各组差异均有统计学意义 (P<0.05) ;各实验组在总穿格数、中央穿格数均减少, 且差异有统计学意义 (P<0.05) ;在周边穿格数检测中, 除中剂量组外, 其余各组均减少, 且低剂量组、3MCC组、吐温组差异有统计学意义 (P<0.05) ; (2) 与3MCC组比较:各药物干预组在旷场中央区活动时间、总穿格数均明显多于损伤组, 在旷场周边区活动时间明显少于损伤组, 差异有统计学意义 (P<0.05) ;在旷场中央与周围穿格数中除低剂量组外, 均明显多于损伤组, 差异有统计学意义 (P<0.05) .在大鼠直立次数中各实验组差异无统计学意义 (P>0.05) .结论 三重脑震荡大鼠伤后17 d出现了明显的焦虑样行为改变, 迷迭香伤后早期干预可明显改善多重脑震荡大鼠的伤后焦虑样行为.     

Traumatic brain injury in high school athletes.

CONTEXT: The potential seriousness of mild traumatic brain injury (MTBI) is increasingly recognized; however, information on the frequency of MTBI among high school athletes is limited. OBJECTIVE: To identify the type, frequency, and severity of MTBI in selected high school sports activities. DESIGN: Observational cohort study. SETTING AND PARTICIPANTS: Two hundred forty-six certified athletic trainers recorded injury and exposure data for high school varsity athletes participating in boys' football, wrestling, baseball and field hockey, girls' volleyball and softball, boys' and girls' basketball, and boys' and girls' soccer at 235 US high schools during 1 or more of the 1995-1997 academic years. MAIN OUTCOME MEASURES: Rates of reported MTBI, defined as a head-injured player who was removed from participation and evaluated by an athletic trainer or physician prior to returning to participation. National incidence figures for MTBI also were estimated. RESULTS: Of 23566 reported injuries in the 10 sports during the 3-year study period, 1219 (5.5%) were MTBIs. Of the MTBIs, football accounted for 773 (63.4%) of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys' soccer, 69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball, 25 (2.1%); baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6 (0.5%). The injury rates per 100 player-seasons were 3.66 for football, 1.58 for wrestling, 1.14 for girls' soccer, 1.04 for girls' basketball, 0.92 for boys' soccer, 0.75 for boys' basketball, 0.46 for softball, 0.46 for field hockey, 0.23 for baseball, and 0.14 for volleyball. The median time lost from participation for all MTBIs was 3 days. There were 6 cases of subdural hematoma and intracranial injury reported in football. Based on these data, an estimated 62816 cases of MTBI occur annually among high school varsity athletes participating in these sports, with football accounting for about 63% of cases. CONCLUSIONS: Rates of MTBI vary among sports and none of the 10 popular high school sports we studied is without the occurrence of an MTBI. Continued involvement of high school sports sponsors, researchers, medical professionals, coaches, and sports participants is essential to help minimize the risk of MTBI.     

脑白质疏松症患者认知功能障碍的特征分析

目的 探讨脑白质疏松症患者认知功能障碍的特征.方法 研究对象来源于2010年9月至2011年3月就诊于首都医科大学附属北京朝阳医院神经内科门诊的46例脑白质疏松症患者和38名年龄、性别、受教育程度相匹配的健康老年人(对照组),采用美国国立神经疾病和卒中研究所-加拿大卒中网血管性认知障碍统一标准推荐的神经心理学评估方法,运用Fazekas量表评价脑白质病变的严重程度,将脑白质疏松症患者分为3组(轻度、中度和重度),比较不同程度的脑白质病变对认知功能的影响.结果 脑白质疏松症患者在总体认知功能评分( MMSE、MoCA)上显著低于对照组(24.4±3.2比28.3±1.2,20.4±3.0比26.2±0.8)(P＜0.05).此外,还在数字广度顺背(5.7±0.9比6.8±1.0)、数字广度倒背(3.5±0.7比4.1±0.7)、Stroop测验B(69±13比43±5)、Stroop测验C(141 ±42比65±10)、连线测验A型(73±15比31±7)、连线测验B型(126±18比82±6)、数字符号测验(25±6比37±5)等测验上成绩差于对照组(P＜0.05),而在言语流畅性(12.7±2.5比13.4±2.5)上差异无统计学意义(P＞0.05).脑白质疏松症患者的Fazekas评分与MoCA成绩呈负相关(r=-0.601,P=0.002).结论 脑白质疏松症患者存在明显的认知功能损害,主要表现为注意和记忆、执行功能、信息加工速度功能受损,这可能与脑白质病变导致的前额叶-皮质下环路功能障碍有关.     

阻塞性睡眠呼吸暂停综合征患者的认知功能改变与其睡眠结构紊乱间的关系

目的探讨阻塞性睡眠呼吸暂停综合征患者(obstructivesleepapneasyndrome,OSAS)认知障碍与其睡眠结构紊乱间的关系。方法所有研究对象(OSAS组:36例,对照组:18例)均进行睡眠多导仪和神经心理测验量表检查,并比较认知功能与睡眠结构间的关系。结果OSAS患者视觉再生(用于检测短时记忆能力)和数字符号(用于检测一般学习能力)两项神经心理测验分数明显低于对照组(P<0.01)。且视觉再生与慢波睡眠长短正相关(r=0.423,P<0.05),数字符号与REM期睡眠长短正相关(r=0.378,P<0.05)。结论OSAS患者短时记忆能力和一般学习能力受损。慢波睡眠和REM期睡眠剥夺可致OSAS患者认知功能障碍。     

双相情感障碍认知功能损害特点的研究

目的 探讨双相情感障碍(BPD)不同临床状态下的认知操作模式.方法 采用8个神经心理测验(共17项)对BPD的不同临床状态病人(躁狂相、抑郁相和缓解期)各30例和正常对照34例进行注意力、言语学习和记忆、视觉记忆和执行功能的评定,用多变量方差分析的方法 比较各组间认知功能的差异.结果 1.急性发作的BPD几乎所有的神经心理学测验成绩均差于正常对照组[躁狂相、抑郁相、缓解期和对照组的WCST完成分类数分别为(1.58±0.90)个、(1.89±1.56)个、(2.44±1.42)个、(4.90±1.73)个;即刻逻辑记忆分别为(10.68±3.92)分、(10.00±3.80)分、(12.11±3.72)分、(15.80±4.21)分],差异有显著性(P<0.05或P<0.01),缓解期BPD在注意力、言语学习和记忆、执行功能上的成绩明显低于正常对照组(P<0.05或P<0.01).结论 急性发作的BPD存在广泛的认知功能损害,而且可持续至缓解期.     

Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools

CONTEXT: Most studies of the long-term effects of early childhood educational interventions are of demonstration programs rather than large-scale public programs. Previous studies of one of the oldest federally funded preschool programs have reported positive effects on school performance, but effects on educational attainment and crime are unknown. OBJECTIVE: To determine the long-term effectiveness of a federal center-based preschool and school-based intervention program for urban low-income children. DESIGN, SETTING, AND PARTICIPANTS: Fifteen-year follow-up of a nonrandomized, matched-group cohort of 1539 low-income, mostly black children born in 1980 and enrolled in alternative early childhood programs in 25 sites in Chicago, Ill. INTERVENTIONS: The Chicago Child-Parent Center (CPC) Program (n = 989 children) provides comprehensive education, family, and health services and includes half-day preschool at ages 3 to 4 years, half- or full-day kindergarten, and school-age services in linked elementary schools at ages 6 to 9 years. The comparison group (n = 550) consisted of children who participated in alternative early childhood programs (full-day kindergarten): 374 in the preschool comparison group from 5 randomly selected schools plus 2 others that provided full-day kindergarten and additional instructional resources and 176 who attended full-day kindergartens in 6 CPCs without preschool participation. MAIN OUTCOME MEASURES: Rates of high school completion and school dropout by age 20 years, juvenile arrests for violent and nonviolent offenses, and grade retention and special education placement by age 18 years. RESULTS: Relative to the preschool comparison group and adjusted for several covariates, children who participated in the preschool intervention for 1 or 2 years had a higher rate of high school completion (49.7 % vs 38.5%; P =.01); more years of completed education (10.6 vs 10.2; P =.03); and lower rates of juvenile arrest (16.9% vs 25.1%; P =.003), violent arrests (9.0% vs 15.3%; P =.002), and school dropout (46.7% vs 55.0%; P =.047). Both preschool and school-age participation were significantly associated with lower rates of grade retention and special education services. The effects of preschool participation on educational attainment were greater for boys than girls, especially in reducing school dropout rates (P =.03). Relative to less extensive participation, children with extended program participation from preschool through second or third grade also experienced lower rates of grade retention (21.9% vs 32.3%; P =.001) and special education (13.5% vs 20.7%; P =.004). CONCLUSIONS: Participation in an established early childhood intervention for low-income children was associated with better educational and social outcomes up to age 20 years. These findings are among the strongest evidence that established programs administered through public schools can promote children's long-term success.     

Correlation between cognitive impairment and prognostic parameters in patients with congestive heart failure

BACKGROUND: Cognitive impairment has been observed in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients with neuropsychological tests attempting to correlate the results with prognostic parameters. METHODS: All subjects underwent a mini-mental state examination (MMSE), memory and learning tests (Corsi Block-tapping test, Verbal Span test, Prose Memory test, Visual Search), anxiety and depression scale test. New York Hospital Association (NYHA) class, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were evaluated. RESULTS: Sixty patients (mean age 65.5 years) were analyzed. NYHA class was 2.9 +/- 0.9, LVEF was 32.9 +/- 13.7%, BNP plasma level 683.3 +/- 864.3 pg/mL. In 23.3% of cases a pathological MMSE score emerged; memory and learning test results were abnormal in 3.4-37%. A positive correlation between MMSE and age (r = 0.18, p = 0.01), BNP (r = 0.25, p = 0.02) was observed but not between MMSE and years of education, NYHA class and LVEF. The Corsi Block-tapping test was related to educational duration (r = 0.12, p = 0.02) with a positive trend for BNP (r = 0.2, p = 0.07). The Prose Memory test and Visual Search were influenced by the patients' educational level (r = 0.36, p = 0.0001; r = 0.27, p = 0.0001). CONCLUSIONS: CHF patients manifest an impairment of MMSE and memory and learning test performance. In our population MMSE correlates to plasma BNP and advanced age.     

活动性癫痫患者神经心理学特征及影响因素研究

目的 评估活动性癫痫患者神经心理学特点及影响因素.方法 60例活动性癫痫患者(过去1年内至少有≥2次的非诱发性发作),以及与之性别、年龄、文化程度、病程、发作类型相匹配的30例发作缓解癫痫患者(评估前至少达1年无发作).采用连线试验、数字符号转换试验、语言流畅性试验、数字广度试验及汉密尔顿抑郁量表(HAMD)等神经心理量表,分别检测癫痫患者心理运动速度、注意力、语言、工作记忆等认知功能及抑郁情绪.结果 活动性癫痫患者较发作缓解癫痫患者数字符号、语言流畅性、数字广度评分低[分别为(47.45±18.812)分、(25.25±8.163)分、(10.39±2.228)分和(56.40±13.631)分、(30.40 ±8.414)分、(11.80±2.074)分];连线A、B耗时长[分别为(64.35±31.710)s、(133.18±47.331)s和(45.47±16.309)s、(98.00±35.003)s];HAMD评分高[(9.12±6.219)分和(3.77±3.997)分];均差异有显著性(P<0.05).多元逐步线性回归分析显示:年龄大是数字符号(β=-0.468,P=0.000)、数字广度(β=-0.439,P=0.000)、连线A(β=0.365,P=0.003)和B(β=0.346,P=0.002)的危险因素,HAMD评分高是数字符号(β=-0.244,P=0.015)的危险因素;而文化程度高、从事脑力劳动及单药治疗对认知功能有保护作用.结论 活动性癫痫患者认知功能损害与多药治疗、抑郁情绪、年龄大、文化程度低、非脑力劳动有关;癫痫患者发作完全缓解后在一定程度上改善认知功能及抑郁情绪.

Abstract：

Objective To assess the neuropsychological characteristics in active epileptic patients and investigate itsrisk factors. Methods Ninety adult epileptic patients included 60 active epileptic patients (two or more unprovoked seizures within 12 months) and 30 age-, sex-, education-, course of disease- and seizure type-matched seizure-free subjects (without epileptic seizure for at least 1 year) . The neuropsychological tests including trail making test,digit symbol test, verbal fluency test,digit span test and hamilton depression scale( HAMD) ,were used to detect mental and motor speed, attention, language, working memory and depression symptoms respectively. The neuropsychological tests were compared between active and seizure-free epileptic patients and identified the risk factors of neuropsychological deficits in active epileptic patients. Results Compared to seizure-free subjects, active epileptic patients had significantly worse scores in digit symbol test, verbal fluency test, digit span test ((47.45 ±18. 812) vs(56.40 ±13. 631), (25. 25 ±8. 163) vs(30.40 ±8. 414), (10. 39 ±2. 228) vs( 11. 80 ± 2.074) respectively) ; more time to accomplish the trail making test A and B((64. 35 ±31.710) vs( 45. 47 ± 16. 309) , ( 133. 18 ± 47. 331 ) vs ( 98. 00 ± 35. 003 ) respectively) ; and higher scores in depressive symptoms ((9.12 ±6.219)vs(3.77 ±3.997) ,all P<0.05). Within active epileptic group,significant predictors of neuropsychological deficits were identified in a stepwise linear regression analysis: advancing age was significantly negatively correlated with digit symbol test(β = -0. 468, P = 0. 000) , digit span test (β = -0. 439, P = 0. 000), trail making test A (β =0.365, P = 0.003) and B(β = 0.346, P=0.002) ; higher scores on depressive symptoms was significantly negatively correlated with digit symbol test (β = -0.244, P = 0.015) ; mental work,high-education level and monotherapy were positively correlated with some of the cognitive function subscales. Conclusion This study suggests that active epilepsy can have a direct adverse effect on cognition and depression symptoms. Multi-drug therapy, severity of depression symptoms, advancing age, low-education level and non-mental work are the predictors of neuropsychological impairment in active epilepsy. In addition, good seizure control even after 1 year can have a beneficial impact on cognitive and depression prognosis.