小血管病性血管性认知障碍非痴呆型患者神经心理学特征的研究

目的通过系列神经心理学测试对小血管病性血管性认知障碍非痴呆型(VCIND-SVD)患者的神经心理学特征进行分析,寻找适用于VCIND-SVD患者的敏感且简捷的神经心理评估工具。方法VCIND-SVD患者33例,正常对照组40例,进行MMSE及多个包括5个认知域在内的神经心理学测试,确定VCIND-SVD患者受损的认知域,筛选出识别能力较好的单项测试,检测其敏感度和特异度,以便临床使用。结果VCIND-SVD患者为多个认知域损害,包括记忆力、注意力、语言功能、视空间结构技能及执行功能均有损害;即刻逻辑记忆测试、积木测试、伦敦塔完成时间及计划时间等检测项目能敏感反映这些损害。结论各单项测试的综合对VCIND-SVD具有较强的识别能力,有重要的应用价值。     

首发急性缺血性脑卒中患者认知功能变化及其与相关因素关系的分析

目的 探讨首发急性缺血性脑卒中患者认知功能障碍情况及其与相关因素的关系.方法 收集佛山市第一人民医院神经内科自2010年7月至2011年6月收治的符合首发急性缺血性脑卒中诊断标准的患者568例,入院1周内进行神经心理学测验,包括简易精神状态检查量表(MMSE)、Mattis痴呆量表、汉化的韦氏成人智力量表数字广度顺背分测验、世界卫生组织-加利福尼亚洛杉矶大学听觉词语学习测验、简化的Rey复杂图形记忆测验、简短Stroop测验干扰部分、语义分类流畅性测验、简短Stroop测验色块部分及简化的Rey复杂图形临摹和画钟测验等,涉及注意力、记忆力、执行功能、信息处理能力、视空间结构能力等认知域.同时记录患者性别、年龄、高血压、吸烟史等临床资料,检测患者血压、血脂[胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血糖(空腹血糖、餐后2h血糖),并对未确诊糖尿病的患者进行葡萄糖耐量试验(OGTT)以判断糖代谢状况.应用统计学方法分析血糖、血脂水平与患者认知功能的关系.结果 (1)568例首发缺血性脑卒中患者中MMSE量表异常率为78.2％,Mattis痴呆量表异常率为72.5％;注意力障碍占26.5％;逻辑记忆即刻障碍占56.3％,逻辑记忆延迟障碍占60.9％,听觉记忆力即刻障碍占74.6％,听觉记忆力延迟障碍占98.2％,视觉记忆力障碍占83.8％;执行功能障碍占62.7％;信息处理能力障碍占4.9％;视空间结构能力障碍占77.7％.(2)不同血糖水平患者之间MMSE量表评分、Mattis痴呆量表评分、注意力评分比较差异均有统计学意义(P＜0.05),且空腹血糖受损组较其他组评分明显降低,差异有统计学意义(P＜0.05).(3)不同类型高脂血症水平患者之间各认知域评分比较差异无统计学意义(P＞0.05).不同HDL-C水平患者在执行功能、画钟测验方面比较差异存在统计学意义(P＜0.05),但在其他认知领域方面组别之间差异无统计学意义(P＞0.05).高水平HDL-C组视空间结构能力评分显著高于正常组,差异有统计学意义(P＜0.05),而高水平HDL-C组执行功能评分则低于正常组,差异也有统计学意义(P＜0.05).(4)Logistic回归分析发现发现MMSE总体评分与性别、年龄、空腹血糖、餐后2h血糖有关;而年龄、性别和HDL-C是执行功能独立危险因素;记忆力与年龄有关,其中即刻听觉记忆力还与HDL-C相关;空间结构能力与年龄、性别及改良Rankin量表(mRS)评分均呈显著相关关系;信息处理能力则仅与HDL-C水平相关.结论 (1)首发急性缺血性脑卒中患者中约75％可存在认知功能障碍,主要以记忆力、执行力、视空间结构能力损害为主.(2)血糖水平尤其空腹血糖受损状况对患者认知功能的损害最为明显.(3)高水平的HDL-C有助于提高患者认知功能.(4)年龄、性别、HDL-C与患者认知功能水平的关系最密切.     

轻型急性缺血性脑卒中早期认知损害的特点和危险因素分析

目的 分析轻型急性缺血性脑卒中早期认知损害的特点和危险因素.方法 连续纳入发病48h内的轻型急性缺血性脑卒中患者(均为前循环梗死)118例,采用蒙特利尔认知评估量表(MoCA)筛选认知损害的患者,分析认知损害的特点及认知损害的危险因素.结果 认知损害患者69例(58.47％),认知损害组在视空间与执行功能、命名、注意力...     

皮质下缺血性脑血管病认知功能障碍研究

目的应用系列神经心理学测试分析皮质下缺血性脑血管病(SIVD)患者的认知损害特征。方法入选SIVD患者53例,年龄及性别相当的健康老年人25例为正常对照组。SIVD患者按照认知损害的诊断标准分为血管性痴呆(VaD)组27例和血管性认知障碍非痴呆(VCIND)组26例。进行MMSE及血管性痴呆包括记忆力、注意力、语言、视空间结构及执行功能5个认知域在内的神经心理学测试,确定VCIND患者受损的认知域。结果①与正常对照组比较,VaD组患者各项量表测试均严重受损,具有统计学差异(P﹤0.05);②VCIND组患者MMSE、数字倒背评分下降,连线测验时间延长,差异有统计学意义(P﹤0.05);③VaD组与VCIND组相比,上述各项均受损严重,其中单词回忆、连线测验、画钟测验、数字广度测验评分差异有统计学意义(P﹤0.05)。结论①SIVD患者同时存在多个认知域损害,以执行功能、注意力损害较为突出,记忆、语言受累相对较轻;②VCIND患者表现为执行功能、注意力受损,程度均低于VaD组,晚期VaD患者全面认知功能明显下降。     

大脑双侧半球病变所致汉语失写的差异

目的探讨大脑双侧半球所致汉语失写症的差异以及神经心理学机制。方法采用汉语失语检查法(ABC)及汉语失写检查法(CAB)测试大脑双侧半球损害患者的口语和书写能力,统计失语类型及失写类型。结果100例患者中,左侧皮层损害Broca失语14例,命名性失语11例,左侧皮层下损害主要是基底节性失语19例;右侧皮层损害纯词哑1例和纯失读1例,右侧皮层下损害全部是基底节性失语7例;左侧皮层损害失语性失写57例,惰性失写12例;左侧皮层下损害语言性失写26例,惰性失写6例;右侧皮层损害全部是语言性失写2例;右侧皮层下损害语言性失写5例,视空间失写1例;两半球损害致失语、失写发生率之间的差异是显著的(P<0.05),左半球损害后失语和失写的发生率均较右半球损害高。结论左右半球协同合作完成汉字语言信息的完整处理。     

脑卒中后抑郁与部位的相关性研究

目的：探讨急性期脑卒中患者影像学改变在脑卒中后抑郁（PSD）患者中的相关性和临床意义,期望早期发现PSD患者并为及时干预提供帮助。方法：对329例急性脑卒中后1个月内患者采用系统的神经心理评估和MRI检查。所有患者均常规行汉密尔顿抑郁量表（HAMD）评分,根据头颅MRJ结果分析病变部位。结果：PSD的发病率以左侧半球脑卒中患者明显高于双侧和右侧半球脑卒中患者,且左侧额叶和基底节尤为突出。不同病灶数目组间比较,PSD的发生率以多灶患者明显高于单灶患者（P〈0．01）。结论：急性脑卒中后PSD与病变部位在左侧半球尤其是左侧额叶、颞叶和基底节区具有显著相关性。完全前循环梗死也是易患PSD的危险因素。     

脑梗死急性期梗死部位及白质病变与认知功能关系的临床分析

【摘要】
目的 研究急性脑梗死患者梗死部位及是否合并脑白质病变对患者早期认知功能的影响。
方法 采用临床痴呆评定量表、简易精神状态检查量表和中文版蒙特利尔认知评估量表对连续入组的急性脑梗死患者进行认知心理学评估,分析患者不同梗死部位包括皮层梗死、皮层下关键部位梗死和皮层下非关键部位梗死及是否合并白质病变对患者认知功能的影响。
结果 急性脑梗死患者血管性认知功能障碍组的平均年龄显著高于无认知功能障碍组（67.31 10.88 vs 57.09 9.91,P=0.015）,神经功能缺损评分显著高于无认知功能障碍组［3.0（2.0～4.0） vs 1.0（1.0～2.0）,P=0.012］。认知功能障碍组的日常生活能力评分显著低于无认知功能障碍组（81.67 23.55 vs 95.91 12.00,P=0.029）。两组患者梗死部位有显著差异（P=0.042）,皮层梗死更多见于血管性认知功能障碍组,皮层梗死患者的视空间与执行功能显著低于皮层下非关键位置梗死患者［1.5（0.0～3.0） vs 3.0（2.0～4.0）,P=0.016］。白质病变与认知障碍的发生无明显相关性。
结论 急性脑梗死患者早期认知障碍与年龄、严重的神经功能缺损、皮层梗死、日常生活能力下降密切相关。     

首次脑梗死后血管性认知功能损害的神经心理学研究

目的探讨首次脑梗死后血管性认知功能损害(CVI)的神经心理学特点。方法以蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)和日常生活活动能力量表(activity of daily living scale,ADL)修订版为神经心理学检测量表,评估70例首次脑梗死患者起病后3个月(病例组)和50例正常者(对照组)的认知功能状态和日常生活能力,并分析不同梗死部位的Mo CA和ADL得分。结果病例组Mo CA、ADL分值较对照组明显下降,差异有统计学意义(P0.05),病例组中43例(61.4%)Mo CA23分;病例组与对照组比较,视空间与执行、注意力、抽象思维能力有显著差异(均P0.05);皮质脑梗死组ADL得分较基底核内囊区脑梗死组低,差异有显著性(P0.05);Mo CA得分无明显差异。结论脑梗死后血管性认知功能减退及日常生活能力下降发生率较高,认知功能减退主要表现为执行功能﹑注意力及抽象思维能力的损害,基底核内囊区与皮质梗死CVA发生率较其他部位高,皮质梗死患者日常生活能力受损较基底核内囊区梗死患者突出。     

脑梗死老年患者责任动脉和认知障碍的关系分析

目的分析脑梗死老年患者责任动脉和认知障碍的关系。方法使用蒙特利尔认知评估表(MoCA)北京版对2012-01-2013-12我院接收的首次急性发病2周左右的缺血性卒中150例患者行认知功能评估(认知功能障碍组)。同时选择同期急性脑梗死患者150例(无认知功能障碍组)。将150例急性脑梗死合并认知障碍患者按照阻塞责任动脉进行分组,对比各组的MoCA认知评估结果和生存质量评分。结果认知障碍组记忆、思维、行动能力、交流、日常生活活动能力等维度评分显著低于无认知障碍组,2组间比较差异具有统计学意义(P0.05)。大脑前动脉供血区梗死组注意力,大脑后动脉供血区梗死组视空间/执行、记忆、语言,大脑中动脉供血区梗死组视空间/执行、语言、注意力、记忆,椎基底动脉供血区梗死组注意力功能受到显著损害,脉络膜前动脉供血区梗死组未发现特征性的认知领域受到损害,差异具有统计学意义(P0.05)。结论不同责任动脉阻塞所导致的认知功能损害的领域不同,这能够预测亚急性期脑卒中后认知障碍,因此应当增加对亚急性期脑卒中管理中的障碍评估。     

听神经瘤对患者认知功能影响的研究

目的研究听神经瘤对患者认知功能的影响。方法纳入40例听神经瘤所致单侧听力下降患者为听神经瘤组,纳入与听神经瘤组患者的年龄、性别、受教育年限相匹配的40例正常人为对照组。进行神经心理测试,比较两组间认知功能的差异,分析可能的影响因素。结果听神经瘤患者的整体认知功能正常,但记忆力、信息处理速度、注意力以及执行功能项显著下降。与左侧听神经瘤比较,右侧听神经瘤对患者认知功能的影响更为明显。相关性分析显示听力受损程度及病程是右侧听神经瘤患者认知损害的重要影响因素。结论听神经瘤可导致患者认知损害,且右侧听神经瘤患者认知损害程度更为显著,临床应重视听神经瘤患者认知状况的评估及保护。     

Neuropsychological abnormalities associated with lacunar infarction

The objective of this study was to assess neuropsychological abnormalities in 40 patients with lacunar infarction. Topography of infarction, presence of isolated or multiple silent infarcts and white matter hyperintensities were correlated with results of neuropsychological tests and subtypes of lacunar infarction. Patients were studied within 1 month after stroke. A total of 21 patients were males and the mean age was 70.7 years; 30% had a single infarction (mean number of infarctions was 3.4). Twelve patients had pure motor hemiparesis, 9 pure sensory stroke, 8 dysarthria-clumsy hand/ataxic hemiparesis, 8 atypical lacunar syndrome, and 3 sensorimotor stroke. The mean score of the Mini-Mental State Examination was 28.4. Mild cognitive impairment of subcortical vascular features occurred in 23 patients and isolated executive disturbances in 4. Neuropsychological results showed that patients with atypical lacunar syndrome followed by pure motor hemiparesis showed significantly more cognitive executive disturbances. Patients with dysarthria-clumsy hand/ataxic hemiparesis accounted for the best scores in some tests of visuoconstructive function and visual memory. In summary, mild neuropsychological disturbances (57.5%) are not infrequent in acute lacunar infarcts especially in patients with atypical lacunar syndrome and pure motor hemiparesis. Neuropsychological impairment should be considered as common clinical feature in acute lacunar infarction.     

Cognitive disorders in acute stroke: prevalence and clinical determinants

BACKGROUND: Although cognitive impairment early after stroke is a powerful predictor of long-term functional dependence and dementia, little is known about the characteristics and determinants of cognitive dysfunction in acute stroke. METHODS: We administered a neuropsychological examination covering 7 cognitive domains to 190 patients within 3 weeks after a first stroke. We also assembled lesion characteristics, clinical factors at admission, demographic characteristics and vascular risk factors. Multivariate logistic regression adjusted for age, gender and education was performed to examine determinants of acute cognitive impairment. RESULTS: Overall, 74% of patients with a cortical stroke, 46% with a subcortical stroke and 43% with an infratentorial stroke demonstrated acute cognitive impairment.Disorders in executive functioning (39%) and visual perception/construction (38%) were the most common. The prevalence and severity of deficits in executive functioning, language, verbal memory and abstract reasoning was more pronounced following left compared to right cortical stroke (all p < 0.05). Intracerebral haemorrhage (OR = 5.6; 95% CI = 1.2-25.4) and cortical involvement of the stroke (OR = 3.6; 95%, CI = 1.3-9.9) were independent determinants of acute cognitive impairment, whereas premorbid moderate alcohol consumption exerted a protective effect (OR = 0.4; 95% CI = 0.1-1.1). CONCLUSIONS: Cognitive impairment is common in the first weeks after stroke, with executive and perceptual disorders being the most frequent. Intracerebral haemorrhage, cortical involvement of the lesion and premorbid moderate alcohol consumption are independently associated with acute cognitive impairment.     

急性腔隙性脑梗死伴脑白质病变对认知功能的变化影响

目的探讨急性腔隙性脑梗死（LI）伴脑白质病变（WML）患者的认知功能障碍特点。方法收集137例患者和正常对照组30例,根据头颅MRIT2加权像及FLAIR像,将病例组分为LI组、WML组和u合并WML组,应用蒙特利尔认知评估量表（MoCA）进行认知评估。结果与对照组相比,WML组的延迟回忆与语言评分明显下降（P〈0．01）;LI组患者注意计算、语言、执行功能评分显著降低（P〈0．01）;LI合并WML组患者延迟记忆、视空间与执行功能评分显著降低（P〈0．01）。与LI组和WML组相比,执行功能障碍在LI合并WML组更明显（P〈0．01）。结论LI合并WML可导致患者认知功能障碍,主要表现为延迟记忆、视空间与执行等认知功能的受损;MoCA在皮层下缺血性脑血管病引起的血管性认知障碍的评定中具有很大的优势。     

Similar subcortical pattern of cognitive impairment in AIDS patients with and without dementia.

The aim of this study was to develop a series of neuropsychological tests that define the cortical and subcortical features of cognitive impairment and the characteristics of memory in demented and mildly cognitively impaired AIDS patients. We attempted to establish a usable method to assess and determine the type and degree of cognitive impairment in individual AIDS patients. We examined 53 patients without central nervous system opportunistic infections. A short battery included two scales of global efficiency (the Mattis dementia rating scale and the Mini Mental State Examination), a psychomotor speed test, an executive control assessment and explicit memory evaluation. Patients were categorized into four groups based on their score on both the Mattis dementia rating scale and the DSM-IV criteria: (1) asymptomatic; (2) having AIDS without cognitive impairment; (3) having AIDS with mild cognitive impairment; and (4) having AIDS dementia. Patients with mildly impaired cognition demonstrated slowed thinking, abnormal initiation and conceptualization, and memory impairment. AIDS dementia patients had slower motor activity and memory recall was more severely affected. The short neuropsychological battery was able to characterize modified cognitive performances in both severely and mildly cognitively impaired AIDS patients. The subcortical pattern of the memory disorder was obvious, regardless of the degree of cognitive impairment.     

Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients

The aims of this study were to investigate the effect of stroke on the corticodiaphragmatic pathway and to clarify the relationships between neurophysiological data and degree of motor disability, site of infarction in CT scan, diaphragmatic excursion, blood gases and pulmonary function in stroke patients. The corticodiaphragmatic pathway was assessed using magnetic stimulation of the scalp sites and cervical roots. The study included 34 sequentially selected patients out of 250 patients with acute ischemic stroke. Twenty-five (age and sex matched) volunteers served as controls. Sixteen patients had cortical infarction, thirteen had subcortical infarction and five had both cortical and subcortical infarction. The mean Scandinavian Stroke Scale was 32.2. Decreased diaphragmatic excursion was observed in 41% of the patients. Twenty-four patients (70.5%) had abnormal magnetic evoked potentials (MEPs) of the affected hemisphere. In five patients MEPs were unelicitable from the affected hemisphere. The remaining nineteen patients had abnormal values of both cortical latency and central conduction time (CCT). Cortical latency, CCT, amplitude of compound muscle action potentials (CMAPs) and excitability threshold of the affected hemisphere were significantly altered compared to both the unaffected hemisphere and the control group. The patients with hemiplegia had a greater degree of hypoxia, hypocapnia and decreased serum bicarbonate level compared to the control group. Additionally, hemiplegic patients had a different degree of respiratory dysfunction. A statistically significant association was found between neurophysiological data and disability score, diaphragmatic excursion, site of infarction in CT scan and degree of respiratory dysfunction. Central diaphragmatic impairment may occur in acute stroke and could contribute to the occurrence of hypoxia in those patients.     

Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients.

This study investigates the effect of stroke on the corticodiaphragmatic pathway and attempts to clarify the relationship between neurophysiological data and degree of motor disability, site of infarction in computerized tomography (CT) scan, diaphragmatic excursion, blood gases and pulmonary function in stroke patients. Using magnetic stimulation of the scalp sites and cervical roots, an assessment of corticodiaphragmatic pathway was made. The study included 34 sequentially selected patients from a total of 250 patients with acute ischemic stroke. Twenty-five (age- and sex-matched) volunteers served as controls. Sixteen patients had cortical infarction, 13 had subcortical infarction and five had both cortical and subcortical infarction. The mean according to the Scandinavian Stroke Scale was 32.2. Decreased diaphragmatic excursion was observed in 41% of the patients. Twenty-four patients (70.5%) had abnormal magnetic evoked potentials (MEPs) in the affected hemisphere. In five patients MEPs could not be elicited from the affected hemisphere; the remaining 19 patients had abnormal values of both cortical latency and central conduction time (CCT). Cortical latency, CCT, amplitude of compound muscle action potentials (CMAPs) and excitability threshold of the affected hemisphere were significantly altered compared with both the unaffected hemisphere and the control group. Those patients with hemiplegia had a greater degree of hypoxia, hypocapnia and decreased serum bicarbonate level compared with the control group. Also, hemiplegic patients had different degree of respiratory dysfunction. A statistically significant association was found between neurophysiological data and disability score, diaphragmatic excursion, site of infarction in CT scan and degree of respiratory dysfunction. Central diaphragmatic impairment may occur in acute stroke and could contribute to the occurrence of hypoxia in those patients.     

简易精神状态量表和蒙特利尔认知评测量表对急性期缺血性脑血管病患者认知功能障碍筛查能力的比较研究

目的比较简易精神状态量表(Mini-Mental State Examination,MMSE)和蒙特利尔认知评测量表(Montreal Cognitive Assessment,MoCA)对急性期缺血性脑血管病患者认知功能障碍的筛查能力。方法对筛选的107例发病7 d内的短暂性脑缺血发作(transient ischemic attack,TIA)或脑梗死患者应用MMSE及MoCA量表进行认知功能障碍的评测,比较经两量表评测筛查出认知障碍患者的比例。根据患者教育程度对应的MMSEI临界值筛选出MMSE评分在正常范围的患者,以MoCA量表评分26分为临界值将受试者分为MoCA评测正常组与异常组,比较两组在各个认知领域的得分。结果 107例患者MMSE平均分25.89±3.65分,MoCA平均分20.67±4.56分。MMSE评测异常者8例(7.5%),正常者99例(92.5%)。MoCA评测异常者98例(91.6%),正常者9例(8.4%)。MoCA评测正常者MMSE评测均正常。MMSE评测正常的99例患者中,MoCA评测正常者9例(9.1%,9/99),评测异常者(26分)90例(90.9%,90/99)。MoCA评测异常组在视空间与执行能力、命名、延迟记忆等认知领域得分低于MoCA评测正常组(P0.05)。结论 MoCA量表在筛查急性缺血性脑血管病患者认知障碍方面可能比MMSE量表更敏感,MMSE正常MoCA评测异常的患者认知损害主要表现在视空间执行功能、命名、延迟记忆等方面。     

Hyperglycemia and cognitive outcome after ischemic stroke

BACKGROUND: Post-stroke hyperglycemia (HG) is associated with poor physical recovery, in particular in patients with cortical stroke. We tested whether HG is also associated with cognitive impairment after ischemic stroke. METHODS: We recruited patients from a prospective consecutive cohort with a first-ever supratentorial infarct. Neuropsychological examination included abstract reasoning, verbal memory, visual memory, visual perception and construction, language, and executive functioning. We related HG (glucose >7.0 mmol/L) to cognition and functional outcome (modified Barthel Index) at baseline and after 6-10 months, and to neurological deficit (National Institutes of Health Stroke Scale) and infarct size at baseline. In additional analyses cortical and subcortical infarcts were considered separately. RESULTS: Of 113 patients, 43 had HG (38%) and 55 had cortical infarcts (49%). Follow-up was obtained from 76 patients (68%). In the acute phase, in patients with cortical infarcts HG was associated with impaired executive function (B=-0.65; 95% confidence limits (CL): -1.3-0.00; p<0.05), larger lesion size (p<0.01), and more severe neurological deficits (p<0.01). These associations were not observed in patients with subcortical infarcts and the association between HG and cognitive functioning at follow-up was not significant in either group. CONCLUSIONS: In first-ever ischemic stroke, HG was not associated with impaired cognition after 6-10 months. In the acute phase of stroke HG was associated with impaired executive function, but only in patients with cortical infarcts.     

Neuropsychological functioning of first-episode schizophreniform patients.

OBJECTIVE AND METHOD: This study compared 32 consecutively admitted first-episode schizophreniform patients, 26 patients with chronic schizophrenia according to the DSM-III-R criteria, and 25 normal comparison subjects on a comprehensive battery of neuropsychological tests to determine the degree of cognitive impairment existing at the onset of schizophrenic illness. Patients were tested within 2 weeks of admission to the hospital, after their medication had been stabilized. RESULTS: With age and education controlled, the first-episode and chronic patients performed significantly worse than the normal subjects on neuropsychological summary measures of executive function, verbal memory, spatial memory, concentration/speed, and global cognitive function and on left and right hemisphere function scales. The first-episode patients were as cognitively impaired as the chronic patients on all summary scales and many of the individual tests. Both groups showed relatively greater left than right hemisphere dysfunction. CONCLUSIONS: These findings suggest that substantial cognitive deficits, comparable to those of chronic patients, are present early in the course of psychotic illness.