帕金森病患者认知功能特点及合并快动眼睡眠障碍对认知功能的影响

目的探讨帕金森病(PD)患者的认知功能特点及PD合并快动眼睡眠障碍(PD-RBD)对认知功能的影响。方法选取PD患者50例(PD组),PD-RBD患者15例(PD-RBD组),健康对照者50名(对照组)。收集3组研究对象的详细人口学资料和临床信息,进行完整的认知功能评估,分析比较PD、PD-RBD患者和健康对照组的认知功能特点。结果单因素方差分析结果显示各组间差异有统计学意义的区域:包括RVLT再认、Rey-Osterrieth复杂图形模仿时间和评分、流畅性测试、符号数字转换测试、Stroop色词测试时间及连线测试的A和B部分。两两比较中,PD-RBD组在RVLT再认、Rey-Osterrieth复杂图形模仿时间、Stroop色词测试时间及连线测试B部分表现最差。结论 PD患者认知功能受损与RBD密切相关,RBD可能是PD认知功能障碍的重要危险因素。     

伴精神病性症状的稳定期双相障碍Ⅰ型患者认知功能MoCA评估及相关因素分析

目的探讨伴精神病性症状的稳定期双相障碍Ⅰ型患者认知功能特点及相关因素。方法选择我院2013-01—2015-01收治的稳定期双相障碍2型72例患者为病例组,根据患者是否伴精神病性症状分为病例2组(n=41,伴精神病性症状)和病例3组(n=31,无精神病性症状),并选取同时期门诊健康体检者40例为对照组,比较3组认知功能评价量表(MoCA)评分,并通过Spearman相关性分析伴精神病性症状的稳定期双相障碍Ⅰ型患者认知功能与相关因素之间的相关性。结果病例组数字符号、数字广度均低于对照组,卡片测验、连线测验成绩高于对照组(P0.05);病例1组和病例2组数字符号、数字广度、卡片测验、连线测验成绩比较差异无统计学意义(P0.05);Spearman相关性分析结果显示,数字符号、数字广度(顺背、总分)、连线测验(连线测验-A、连线测验-B)与YMRS评分、HAMD评分存在显著相关性(P0.05)。结论伴精神病性症状的稳定期双相障碍Ⅰ型患者认知功能存在明显受损,且与患者抑郁、躁狂程度及病程有密切关系。     

团体认知行为治疗对强迫症患者认知功能的影响北大核心CSCD

目的探讨团体认知行为治疗对强迫症患者症状缓解和认知功能改善的效果。方法纳入符合DSM-IV-TR诊断标准的强迫症患者48例,按1:1的比率分入药物治疗联合团体认知行为治疗组(联合治疗组,n=24)和药物治疗组(n=24)。联合治疗组进行8周药物治疗及8次团体认知行为治疗,药物治疗组患者进行8周药物治疗。采用Y—BOCS评估治疗前后强迫症状,采用神经心理测试(包括连线测验、数字符号测验、数字广度测验、语义流畅性测验)评估治疗前后的认知功能。结果治疗前联合治疗组与药物治疗组Y—BOCS总分及神经心理测试结果差异均无统计学意义。治疗后联合治疗组Y—BOCS评分[(18.7±3.1)分与(20.7±1.8)分]显著低于药物治疗组(t=2.75,P<0.05);联合治疗组在连线测验中的B时间,数字符号测验,数字广度测验中的顺背、倒背以及语义流畅性测验中的正确数与药物治疗组比较差异均有统计学意义(t=-2.93,3.47,2.06,2.54,7.22,均P<0.05或P<0.01)。结论团体认知行为治疗能有效缓解强迫症患者的症状严重程度,改善强迫症患者的认知功能。     

利用核磁共振局部一致性研究iRBD基底节区的早期损害

目的特发性快眼动睡眠行为障碍(idopathic rapid eye movement sleep behavior disorder,iRBD)又称帕金森病临床前期,为寻找其早期损害的证据,利用功能核磁共振探查其早期大脑自发活动性的改变,以提供其脑损害的影像证据。方法选取符合诊断标准的iRBD 21例,性别、年龄匹配的健康对照组22例,进行认知量表及统一帕金森病等级评分-运动部分(Unified Parkinson’s Disease Rating Scale motor section,UPDRSⅢ)测评,并进行功能磁振扫描,利用局部一致性(region homogeneity,Re Ho)方法进行数据分析;结果与正常对照组相比,iRBD组ReyOsterrieth复杂图形测验(ROCFT)、听词语学习测验(AVLT) N1、N2、N3、符号数字模式测验(SDMT)、数字排序测验-注意力部分(DOT-A)得分均下降(U=133.5、t=-2.416、t=-2.873、U=134.5、U=81.0、U=144.5,P 0.05),连线测验B(TMT-B)及UPDRSⅢ得分明显增加(U=138.0、U=121.0,P 0.05);与对照组比较,iRBD组基底节区右尾状核、左壳核、右壳核及右苍白球局部一致性明显下降(t=-4.611、t=-4.360、t=-4.298、t=-3.422,P 0.05)。结论 iRBD患者存在视空间、记忆、执行、注意及运动方面损害,其基底节区神经团块内部自发活动一致性明显下降,提示基底节区功能活动异常,可能是iRBD早期基底节损害的标记。     

奥氮平与利培酮对精神分裂症认知功能影响的对照研究

目的 比较两种非经典抗精神病药奥氮平、利培酮对精神分裂症病人认知功能的影响.方法 62例急性发病期的精神分裂症患者(包括首发与复发)为研究对象,随机分为两组,分别予以奥氮平、利培酮治疗12周,在基线和12周末分别用阳性与阴性症状量表(PANSS)及副反应量表(TESS)、韦氏智能测验的数字广度和数字符号测验、连线测验A、连线测验B、MMSE依次评价疗效、安全性、认知功能.结果 12周末时两组的PANSS量表总分和各因子分较基线时有显著差异,治疗后两组之间无统计学差异.12周末与基线时比较奥氮平在数字广度顺背数、数字符号、TMT-A连线时间、TMT-A正确数、TMT-B连线时间、MMSE比较差异有统计学意义(P＜0.05).利培酮组在数字广度、数字符号、TMT-A连线时间、TMT-B连线时间、MMSE上有统计学的差异(P＜0.05).12周末时,两组之间相比较,显示利培酮在数字广度顺背数、TMT-B连线时间比较差异有统计学意义(P＜0.05).两组之间不良反应比较,利培酮组肌强直高于奥氮平组,差异有统计学意义(P＜0.05).结论 奥氮平组和利培酮组治疗精神分裂症疗效相当,改善认知功能疗效相当,利培酮可能在改善注意方面优于奥氮平.     

抑郁对帕金森病患者执行功能的影响

目的 探讨抑郁对帕金森病(PD)患者执行功能的影响。方法 对41例PD患者及20例对照组进行整体认知功能、执行功能及抑郁状况的评定。整体认知功能评定使用简易智力状态量表(MMSE); 执行功能评定包括言语流畅性测验(VFT),连线测验(TMT),Stroop字色干扰测验(SCWT),画钟测验(CDT),数字符号替换测试(DSST)及数字广度测试(DST)等; 使用贝克抑郁自评量表(BDI)评估抑郁状态。结果 抑郁组SFT, PFT, DST, DSST, CDT, TMA,TMB, Stroop-B, Stroop-C,SIE评分均差于对照组(P<0.05); 非抑郁组PFT, DST, DSST,TMA,TMB, Stroop-C,SIE评分差于对照组(P<0.05); 与非抑郁组比较,抑郁组SFT, PFT, DST, DSST, TMA, TMB, Stroop-B, Stroop-C, SIE评分较差(P<0.05)。结论 PD患者存在明显的执行功能障碍,抑郁可以明显加重PD患者的执行功能障碍。     

稳定期双相障碍Ⅰ型患者认知功能损害与脑白质病变的研究

目的研究稳定期双相障碍Ⅰ型患者认知功能损害与脑白质病变的关系。方法共选择68例诊断双相障碍Ⅰ型稳定期患者,作为观察组,同期选择60例健康志愿者作为对照组;采用数字符号测验、数字广度测验、视觉图形再生测验、连线测验、言语流畅性测验、威斯康星卡片分类测验和汉诺塔测验7种测量工具评估认知功能,采用扩散张量成像(DTI)技术分析脑白质病变。结果观察组认知功能评估均差于对照组,差异有统计学意义(P0.05)。观察组的胼胝体、颞叶和基底节区FA值明显低于对照组,相应ADC值则高于对照组,差异有统计学意义(P0.05);额叶、枕叶和小脑区域FA值和ADC值比较无差异(P0.05)。结论稳定期双相障碍Ⅰ型患者存在一定程度的认知功能损害,可能与胼胝体、颞叶和基底节区的脑白质病变有关。     

慢性吸烟者的认知功能调查

目的 了解吸烟者和正常对照者的认知功能差异及提出改善办法.方法 采用认知功能测试量表（包括:数字符号测验、连线测试A和stroop色词测验）对两组人群进行认知功能测试.结果 吸烟者在数字符号测验、连线测试A和stroop词测验方面得分都较正常对照者低,而两组的stroop颜色测验没有差异.结论 本测试结果显示吸...     

难治性精神分裂症患者及亲属的临床特征和认知功能分析

目的探讨难治性精神分裂症患者及其亲属的临床特征及认知功能。方法:采用PANSS、数字广度和数字符号测验对符合DSM-IV精神分裂症诊断标准和难治性标准的139例患者,66例非难治性患者,以及118例难治性患者亲属,100例正常对照进行认知功能和临床症状的评定。结果:难治性精神分裂症患者在发病年龄、未治期、病程、阴性分量表评分与非难治性患者有显著性差异(P<0.05);在教育年限、数字广度、数字符号方面无显著性差异(P>0.05)。数字广度、数字符号比较,难治性患者、非难治性患者及一级亲属与正常组均有显著性差异(P<0.05)。数字广度和数字符号测验结果与难治性患者的病程、PANSS阴性量表评分和未治期呈显著负相关(P<0.05),与教育年限、起病年龄呈显著正相关(P<0.05)。结论:难治性精神分裂症患者有其特殊的临床特征,和其亲属都具有认知功能的损害。     

首发精神分裂症患者的认知功能与脑灰质体积的相关研究（英文）

背景:认知功能损害是精神分裂症的核心症状之一,其恢复程度关系到患者能否重新回归社会。目的:明确精神分裂症认知功能与脑灰质体积的关系。方法:采用画钟测试、连线测试、数字广度测试、听觉词语测试、威斯康星卡片分类测验、言语流畅性测试、语义相似性测验、斯特鲁色词测试对37例首发精神分裂症住院患者(病例组)和30名健康对照组(对照组)进行神经认知功能检测,采用面孔情绪认知任务测试对32例首发精神分裂症住院患者(病例组)和29名健康对照组(对照组)进行面孔情绪认知功能检测,采用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)评定首发精神分裂症住院患者的精神症状,利用磁共振分别对病例组和对照组进行脑部影像学数据的采集。结果:病例组和对照组在画钟测试、连线测试、数字广度测验、听觉词语测验、威斯康星卡片分类测验、言语流畅性测验、语义相似性测验、斯特鲁色词测验反应时间中,两组间的差异有统计学意义;面孔情绪认知任务测试斜率(Slope)之间有统计学意义;病例组与对照组的脑灰质体积差异比较发现病例组的左侧额上回的灰质体积增加,左侧枕下回、舌回和小脑上部灰质体积减少;病例组神经认知数据与脑影像学数据分析,斯特鲁色词测验中的卡片C正确反应个数测验分数,显示与左侧额上回和右侧额上回、额中回灰质体积负相关;病例组面孔情绪认知任务与脑影像学数据分析,病例组转换斜率数据的相关灰质异常脑区为与右侧颞上回、颞中回,左侧颞中回、颞下回和梭状回灰质体积成正相关。结论:首发精神分裂症住院患者的神经认知功能和面孔情绪认知功能存在广泛性损害,上述结果提示灰质体积异常脑区可能为认知功能障碍的脑结构和功能基础。     

Gap-task模式下反射性视觉诱导性眼扫动的左侧皮层控制机制

目的研究gap-task模式下反射性视觉诱导性眼扫动的左侧皮层控制机制.方法以左侧额叶脑梗死患者、左侧顶叶脑梗死患者与正常受试者为研究对象,按照gap-task模式测定左右眼扫动速度及潜伏期,并观察眼动波形,通过组间对照以探讨该模式眼扫动的皮层控制机制.结果左侧顶叶病变患者出现双向启动延迟,但以右向眼动的受累更为显著;左侧顶叶与额叶病变均会引起右向眼扫动准确性下降.结论对于gap-task模式下反射性视觉诱导性眼扫动,左侧顶叶可以启动双向眼动,并表现出支配向右侧的眼球运动优势,额叶则不参与启动过程;左侧顶叶与额叶共同参与调节向对侧的眼球运动幅度,以保证眼扫动的准确性.     

Histological and magnetic resonance imaging assessment of cortical layering and thickness in autism spectrum disorders.

BACKGROUND: Qualitative reports of the cerebral cortex in a small number of autism spectrum disorder (ASD) cases have suggested an increase in thickness and disruptions in migration and lamination patterns. METHODS: We examined postmortem ASD individuals and age-matched controls using magnetic resonance imaging (MRI) to evaluate total cortical thickness, and histological samples to evaluate the pattern of cortical layering. RESULTS: Overall, thickness measures from ASD subjects were equivalent to control cases. Individual regions showed marginal but nonsignificant thickness differences in the temporal lobes. Cortical thickness values in ASD subjects decreased significantly with age. Quantitative examination of proportional layer thickness in histological sections indicated that the pattern of cortical layering was largely undisturbed, while qualitative examination of these same samples revealed evidence of cell clustering and supernumerary cells in layer I and the subplate. These features were not severe and were never found in a majority of cases. CONCLUSIONS: These findings support limited disturbances in cortical cell patterning, but do not indicate a major deficit in the orderly migration of cortical neuroblasts during development, or their subsequent aggregation into the laminar pattern found in typically developing individuals.     

Local-global processing in Alzheimer's disease: an examination of interference, inhibition and priming

Impairments of memory, praxis, gnosis, language and executive functioning are well documented in Alzheimer's disease (AD). Functions, such as attention, however, have only recently been systematically investigated. We used Navon-type stimuli (large "global" digits composed of smaller "local" digits) to assess 12 AD participants' plus age-matched controls' ability to focus and alter the scale of their spatial attention. In the first experiment, participants responded to either the global or local characters within a block, ignoring characters at the other spatial scale. Healthy young adults (n=12) demonstrated the normal 'global precedence' effect on this task. In contrast, participants with AD and their age-matched controls were significantly faster on the local task than on the global task, suggesting in these groups a 'local precedence' effect. This consisted of both a local advantage and a local-on-global interference effect. In a second experiment, participants searched for designated targets which occurred unpredictably at either the local or global spatial scale. Participants with AD were significantly slower and more error-prone than older controls. In addition, participants with AD showed a greater cost in reaction time (RT) when required to switch spatial scales on consecutive trials, compared to no switch responses at the same spatial scale on consecutive trials. Thus, AD may impair the ability to process global figures, due perhaps to involvement of posterior parietal areas. Further, participants with AD were poor at inhibiting irrelevant stimuli and at inhibiting attentional allocation to an irrelevant spatial scale, which may relate to prefrontal pathology.     

Spectral EEG During Short-Term Discontinuation of Antiepileptic Medication in Partial Epilepsy

Summary: The effect of short-term discontinuation of antiepileptic drugs (AEDs) on spectral analysis of EEG background activity (spectral EEG) was studied in patients undergoing preoperative evaluation for epilepsy surgery. We also wished to clarify whether AED discontinuation would provide lateralizing evidence in spectral EEGs of patients with temporal lobe epilepsy (TLE). Spectral EEGs were performed in 15 patients receiving their regular medication regimen and again after a 1-week period during AED withdrawal. A subgroup of 9 patients who had previously undergone temporal lobectomies (TLE group) was studied separately. In this group, we evaluated the effect of preceding seizures on spectral EEG derived from temporal neocortical areas. In all patients, spectral EEG changes were detected even after a short-term AED withdrawal. The total amount of absolute delta activity was reduced and occipital peak frequency and relative alpha activity were increased as compared with baseline values. In TLE patients with habitual seizures occurring <20 h before the spectral EEG recording, lateralization was correctly identified by the greater amount of absolute delta activity ipsilateral to the epileptogenic focus. Epileptic seizures are accompanied by subtle focal slowing in spectral EEG for a much longer period than has been assumed. In addition, postictal spectral EEG over the temporal lobes may have lateralizing value. Further studies in larger numbers of patients are needed to evaluate the role of spectral EEG in the preoperative evaluation of patients for temporal lobe surgery.     

颞-枕叶交界区癫痫的致痫区定位研究

目的 探讨颞-枕叶交界区癫痫的脑电图、电临床症状学特点及其在致痫区定位诊断中的意义.方法 7例怀疑颞-枕叶交界区癫痫的患者,进行了长程视频脑电图监测,根据电生理及头颅MRI结果,进行术前评估及颞-枕叶交界区病灶切除,随访1年.结果 (1)发作起始的症状和体征:所有患者无论病史和监测中均无初级视幻觉,7例中2例有视错觉或复杂视幻觉;快速眨眼(有或无发作先兆)做为发作起始的体征见于6例患者中;(2)头皮脑电图间歇期癫痫样放电位于双侧4例,同侧颞-枕区2例,同侧颞区1例;头皮脑电图发作期7例中5例发作起始表现为弥漫性放电,无侧向性,1例位于同侧后头部,1例为同侧颞区;(3)手术及预后:7例患者中5例行颞-枕交界区病灶切除术,2例术后完全无发作,1例术后有偶发先兆,2例患者术后发作未减少;另外2例未接受外科治疗.结论 发作起始期先兆症状学可为颞-枕叶交界区癫痫致痫区定位诊断提供重要线索,而头皮脑电图间歇期和发作期癫痫放电对颞-枕叶交界区癫痫致痫区定位只能提供参考线索.正确和充分的颅内电极(特别是深部电极)置入并记录发作期颅内电极脑电图改变,对发作起始区的定位诊断可能提供更重要的资料.     

Electrophysiology of Bimanual-Bipedal Automatisms

Summary: To determine the localizing value and electrophysiology of bimanual-bipedal automatisms (BBAs), we studied these behaviors in 54 seizures of 8 patients with temporal or frontal lobe seizure onset. BBAs occurred with a frequency of 27% in frontal lobe epilepsy (FLE) and of 7% in temporal lobe epilepsy (TLE). The distribution of electrode sites showing ictal activity during these automatisms was significantly different in the two patient groups (0.0001 Chi-square). Mesioand/or laterotemporal plus orbital frontal areas were involved areas when the behaviors appeared in patients with TLE; dorsolateral and mesiofrontal regions were the most commonly involved when the behaviors occurred during the course of frontal lobe seizures. We concluded that BBAs represent activation of frontal lobe circuitry but are not unique to seizures of frontal lobe origin. Eyelid flutter and repetitive body movements in either the axial or sagittal plane were significantly associated with the frontal lobe group whereas oral-alimentary automatisms were associated with the temporal lobe group. Thus, these associated behaviors may help indicate whether a frontal or temporal lobe seizure onset has occurred when BBAs are observed. A new concept of ictal expression is proposed to conform with the results as well as with other apparently disparate ictal behaviors that may have localizing value.     

鉴别额叶癫痫及颞叶癫痫的临床症状学提示

目的:比较额叶癫痫(FLE)及颞叶癫痫(TLE)的临床症状学区别。方法:纳入2005年10月至2007年3月我院癫痫中心门诊临床诊断为额叶癫痫患者190名,颞叶癫痫患者257名。纳入病例满足发作间期脑电图至少一次具有局限于额叶或颞叶的放电或发作期脑电图明确提示额或颞叶起源;排除所有发作间期脑电图正常、存在多灶或定位不清的脑电异常及影像学检查具有额或颞叶以外的局灶损害者。由两位不知道患者脑电图和影像学结果的临床医生单独分析患者发作情况(先兆、复杂部分发作(CPS)、继发全面强直阵挛发作(SGTC))。用χ2检验统计数据。结果:提示颞叶癫痫最有意义的先兆是经验现象和胃气上升感(P<0.01)。情感表现在TLE中更常见(P<0.05)。口咽自动症与手部自动症是颞叶癫痫患者的典型CPS表现(P<0.01)。而躯体自动症,偏转性强直-肢体与头眼及SGTC、姿势性强直,局部阵挛发作,发作时伴随出声、植物神经症状是额叶癫痫患者的典型CPS表现(P<0.01)。发笑、震颤症状在二类中均可出现,以额叶居多(P<0.05)。言语终止,自言自语,单纯凝视发作对于二者的鉴别意义不大。额叶癫痫组具有两种以上CPS发作的病例更多(P<0.01)。结论:额叶癫痫与颞叶癫痫的症状学特征是不同的,对于临床诊断有重要价值。     

MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.     

MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.