颞叶癫痫患者认知功能及其影响因素的研究

目的观察颞叶癫痫患者的认知功能状况,并进一步探讨社会人口学、临床发作、癫痫样放电等因素对患者认知功能的影响。方法对129例颞叶癫痫患者和90名健康对照者进行韦氏成人智力量表中国修订本(WAIS-RC)和临床记忆量表测定。结果颞叶癫痫患者总智商(full intelligence quotient,FIQ)、言语智商(verbal intelligence quotient,VIQ)、操作智商(performance intelligence quotient,PIQ)及记忆商(memory quotient,MQ)均明显低于健康对照者(P<0.001)。癫痫患者文化程度越高,其IQ及MQ越高(P<0.01);癫痫患者发作越频繁,其IQ及MQ越低(P<0.01);癫痫患者癫痫样放电越明显,其IQ及MQ越低(P<0.01)。多元逐步回归分析显示,影响患者FIQ和MQ的因素依次为发作频率和脑电图癫痫样放电。结论颞叶癫痫患者存在不同程度的认知功能障碍。关注颞叶癫痫患者的认知功能以及合理选择治疗方法、尽快控制癫痫发作是避免和减少患者认知功能损害的重要前提。     

颞叶癫痫患者认知功能及相关因素的分析

目的分析颞叶癫痫患者认知功能的状况,并进一步探讨性别、病程、临床发作、神经电生理及药物等因素对患者认知功能的影响。方法从我院2002～2010年住院部中抽出符合入选标准的55例颞叶癫痫患者及随机抽取的同期48例健康对照者的韦氏成人智力量表、韦氏成人记忆量表、H.R.成人神经心理成套测验记录测验值进行回顾性分析。结果颞叶癫痫患者全量表智商(full intelligence quotient,FIQ)、记忆商(memory quo-tient,MQ)均明显低于健康对照者(P<0.001),脑病损程度(disease quotient,DQ)明显高于健康对照者(P<0.001)。不同文化程度的颞叶癫痫患者IQ、MQ、DQ有显著性差异,文化程度越高,其IQ及MQ越高(P<0.01),DQ越小(P<0.01);不同发作频率的颞叶癫痫患者IQ、MQ及DQ有显著性差异,发作越频繁,其IQ及MQ越低(P<0.01),DQ越高(P<0.01);不同脑电图异常改变的颞叶癫痫患者IQ、MQ和DQ有显著性差异,癫痫样放电越明显,其IQ及MQ越低(P<0.01),DQ越高(P<0.01)。多元逐步回归分析显示,影响患者IQ、MQ及DQ的因素依次为发作频率和脑电图癫痫样放电。结论颞叶癫痫患者存在不同程度的认知功能障碍。关注颞叶癫痫患者认知功能状况,尽早采取有效的治疗方法控制癫痫发作是避免和减少患者认知功能障碍,提高生活质量的重要前提。     

脑血管病变对记忆的影响：171例神经心理测验总结

报告171例脑血管病患者的神经心理测验结果,其中118例(69％)的韦氏记忆量表WMS低于85MQ,MQ在70～84者37例,54～69者32例,<54者49例,以倒计数,理解和触觉等分测验更为明显。58例同时做了韦氏成人智力量表(WAIS),智商(IQ)低于85的有17例,34例做H.R成套心理测验,损伤指数(DQ)≥0.3者有21例。提示在脑血管病患者中有很大部分的脑功能受到不同程度的影响。     

不同检测手段在脑梗死患者临床评估中的价值

目的 :探讨神经心理学量表、脑电生理及 MRI检查在脑梗死患者临床评估中的价值。方法 :对 5 5例脑梗死患者发病后一个月进行神经心理学上脑高级功能的评估 ,并进行了常规脑电图 ,P30 0及 MRI检查。其中神经心理学量表的检查包括 MMSE、韦氏智力及临床记忆量表检查。结果 :智商、临床记忆量表得分及 P30 0潜伏期检查患者组较对照组下降有明显差异。MRI所显示的病变大小与患者的认知功能和短时记忆明显相关。P30 0潜伏期不仅与认知功能明显相关 ,而且与韦氏智力有一定的相关性。结论 :合理的应用神经心理学量表检查可以全面地反映不同脑梗死患者脑功能障碍的不同侧面。脑梗死面积大小明显影响患者的认知功能和短时记忆。P30 0可以作为脑梗死患者认知功能评估的敏感指标。     

无框架立体定向海马杏仁核毁损术治疗颞叶内侧癫痫的神经心理学评估

目的了解无框架立体定向海马杏仁核毁损术在治疗颞叶内侧癫痫中对神经心理学功能的影响。方法 61名MRI阴性药物难治性颞叶癫痫患者在全麻下行经额旁正中入路无框架立体定向海马杏仁核复合体毁损术;其中23例成人患者分别在术前、术后一周及术后6个月进行了韦氏记忆量表及韦氏智力量表检测评分。结果回访时间14～82个月不等,EngelⅠ级31例,Ⅱ级3例,Ⅲ级8例,Ⅳ级19例,痫性发作消失率(EngelⅠ)51%。手术前受试者的平均记忆商数、平均智力商数都明显低于健康人群中常值范围。术后一周较术前下降(P<0.05)的有语言智商、操作智商及记忆商数,总智商下降不明显(P>0.05);术后6个月以后受试者较术前明显增加(P<0.05)的有总智商、语言智商、操作智商及记忆商数。右颞叶内侧毁损者言语智商较术前明显增加(P<0.05)。结论无框架立体定向海马杏仁核毁损术术后早期存在记忆力及智力下降,但此类认知功能的下降程度较轻,且会在术后6个月内恢复甚至较术前明显改善,远期来讲右侧手术者其语言智商改善更为明显。无框架立体定向海马杏仁核毁损术在神经心理学功能保留方面是可逆的、甚至是有益的。     

精神分裂症患者认知功能与精神症状相关性研究

目的：探讨精神分裂症患者认知功能与精神症状的相关性。方法：对40例精神分裂症患者于治疗前、治疗12周末分别进行韦氏成人智力量表（WAIS-R）、韦氏记忆量表（WMS）、H—R神经心理成套测验（HRB）中的连线测验A、威斯康星卡片分类测验（WCST）及言语流利性测验及简明精神病评定量表（BPRS）评定。结果：治疗前焦虑抑郁因子分与总记忆商数（MQ）分显著相关，迟滞因子分与WCST完成类别数、智力显著相关；治疗12周末焦虑抑郁因子分与总智商（IQ）显著相关，迟滞因子分与WCST持续反应数、言语IQ、操作IQ显著相关，猜疑因子分与WCST持续反应数显著相关。结论：精神分裂症患者部分认知功能与精神症状显著相关。     

儿童精神分裂症认知功能研究

目的:探讨儿童精神分裂症患者的认知功能及与临床症状的关系. 方法:60例未经治疗的儿童首发精神分裂症患者(研究组)和30名健康学龄儿童(对照组),采用中国韦氏儿童智力量表(C-wIsc)、临床记忆量表和瑞文标准推理测验进行认知功能评定;研究组以阳性症状量表(SAPS)和阴性症状量表(SANS)进行临床评估. 结果:研究组总智商(FIQ)评分(97.2±15.6)分,言语智商(VIQ)(100.4±12.6)分和操作智商(PIQ)(90.5±15.3)分显著低于对照组的(115.3±13.7)分,(119.2±11.8)分和(110.6±14.8)分(P均=0.000).研究组等值记忆商MQ评分(70.5±15.2)分显著低于对照组(105.9±13.8)分(P均<0.001).研究组瑞文标准推理测验标准分中位数为5分,对照组为3分(X<'2>=6.44,P<0.05).研究组IQ、MQ及瑞文标准推理测验与SAPS阳性症状评分无显著相关,但与某些SANS阴性症状评分显著相关(r=-0.36,-0.42;P<0.05或P<0.01). 结论:儿童精神分裂症患者存在认知功能障碍,表现为智力发展不平衡、记忆障碍以及执行功能障碍;临床记忆及瑞文标准推理测验缺损与阴性症状严重程度有一定的关系,但与阳性症状无关.     

颅内肿瘤患者智力损害的评价及术后随访

目的 评价颅内肿瘤及神经外科手术对患者智力的影响.方法 运用中国修订韦氏成人智力量表(WAIS-RC)对79例颅内肿瘤患者进行智力评估.按照简式(四合一)算法换算智商(IQ)、言语智商(VIQ)和操作智商(PIQ).结果 脑叶内肿瘤患者术前IQ(P＜0.01)、VIQ(P＜0.01)均显著低于健康对照组;优势半球肿瘤组术前IQ、VIQ明显低于健康对照组和非优势半球组;鞍区肿瘤组患者无智力受损.术后凸面脑外肿瘤组IQ、PIQ均降低.结论 颅内肿瘤可导致患者智力损害,脑叶内肿瘤及优势半球肿瘤所致智力损害较严重;神经外科医生应重视颅内肿瘤及其手术对患者智力的影响.     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

酒中毒患者的认知特点

目的：探讨酒中毒患者的认知特点。方法：采用中国成人智力量表（CISA）、韦氏记忆量表－中国修订（WMS）、酒精依赖诊断量表（SCID－AD）和自编饮酒情况调查表对被试者进行测验和调查。酒中毒患者49例,正常人30例。结果：酒中毒患者与正常人CISA各量表分、智商、各种智力因素商比较,具有显著或极显著差异。两组WMS各量表分和记忆商数比较也具有显著或极显著性差异。酒中毒患者记忆下降比例明显高于智力下降比例,且下降程度也要严重得多。结论：酒中毒患者的认知功能有明显下降,记忆的下降程度比智力的下降程度更为严重,明显受病程和开始饮酒年龄的影响。“流体智力”下降的速度比“晶体智力”方面的能力更快。     

Premenstrual changes and changes in gonadal hormones

Changes in plasma levels of estradiol and progesterone and their temporal relationship with changes in mood and behavior were studied along the menstrual cycle in 17 normal women with a wide range of severity and types of premenstrual changes (PMC). Emphasizing changes in hormonal levels over time as well as their rates of change, selective clinical features of premenstrual changes were found to be positively associated with peak levels of progesterone, its rate of decrease over time, and the ratio between the rates of decrease-over-time of progesterone and estradiol levels. A time-lag of 4-7 days between changes in plasma levels of progesterone and changes in clinical features was also found. Rate of change of estradiol was somewhat associated with clinical PMC. It is suggested that the association between gonadal hormones, other biological changes, and mood should be further studied as a diversified, dynamic, time-related process.     

Pre-ictal autonomic changes

Autonomic measures frequently alter with seizure activity and with brain state and so theoretically, there could be pre-ictal changes in autonomic function. However, there are considerable confounders. First, the measurement of autonomic function is not straightforward; heart rate and measures derived form heart rate have been those that have used the most in assessing changes in autonomic function. Second, autonomic function can vary considerably over the 24h cycle and can change suddenly depending on internal and external stimuli (e.g. fear, pain) and so any measures of changes in autonomic function will lose specificity. Third, changes in autonomic function in response to seizures, depends upon the individual, seizure type and spread of the seizure and even then can vary from seizure to seizure in the same individual. The idea that there will be well-defined, unique autonomic changes that occur in the pre-ictal period is very unlikely. These factors make it unlikely that autonomic function monitoring can be used successfully as a means of seizure prediction. However, in sleep, changes in autonomic function relate to changes in arousal state and since such states and the transition between such states may predict seizure occurrence in certain individuals, autonomic function could be a helpful determinant of seizure risk at certain stages of sleep. This hypothesis has, however, yet to be tested.     

Interaction between cardiac beat-to-beat interval changes and systolic blood pressure changes

Abstract. This study assessed the interaction between cardiac beat-to-beat interval changes and systolic pressure (SP) changes. Twenty subjects breathed regularly following displayed breathing signals at 4, 6, 8, 10, 12 and 14 breaths per minute, each for 5 minutes. ECG, non-invasive blood pressure (Finapres) and respiration waveforms were recorded. Time offsets between the cyclic patterns of RR-interval and SP changes were calculated. Displayed breathing signals were well followed; the mean correlation between displayed and recorded breathing signals ranged from 0.72 to 0.86. The time offset between RR-interval peaks and subsequent SP troughs decreased with increasing respiration rate, 3.8 ± 1.7 s, 3.5 ± 0.7 s, 3.1 ± 0.6 s, 2.6 ± 0.4 s, 2.3 ± 0.4 s and 2.0 ± 0.4 s mean ± SD at 4, 6, 8, 10, 12 and 14 breaths per minute respectively. The relationship between mean time offset and frequency was significant (p < 0.001), with a 95% prediction interval of ± 0.24 s. Published data showed no relationship between time offset and frequency, with a 95% prediction interval of ± 2.8 s. However, when the offset definition proposed in this research was applied to these data, a significant relationship (p < 0.01) was evident, with a 95% prediction interval of ± 1.5 s. In conclusion, apparently contradictory previous findings achieve good consensus when a standardized method for presenting results is applied. A delay exists between RR-interval and blood pressure changes, and this delay varies with breathing frequency.This study was supported by the British Heart Foundation.     

Visual mismatch negativity to irrelevant changes is sensitive to task-relevant changes

Event-related potentials (ERPs) were measured in response to frequent (standard) and infrequent (deviant) task-irrelevant bar patterns. The constituent bars of the deviant patterns had either different orientation or different color than the bars of the standard. The task was the detection of either the orientation or the color change of a centrally presented shape. The deviant minus the standard ERP difference produced posterior negativity and was identified as visual mismatch negativity (vMMN). On the one hand, vMMN to orientation deviancy had smaller amplitude in the task demanding detection of the orientation change, and vMMN to color deviancy had smaller amplitude in the task demanding the color change. On the other hand, irrelevant deviancy influenced the task-performance. Reaction time (RT) to the orientation change of the target shape was longer in sequences with orientation change in the background, whereas RT to color change was longer in sequences with color change in the background. This interaction suggested that there was competition between the processing of irrelevant stimuli that share characteristics of task-related changes and target-related processing.