慢性脑供血不足致非痴呆型血管性认知功能障碍患者的神经心理及事件相关电位的研究

[摘要]目的：探讨慢性脑供血不足（chronic cerebral vascular insufficiency,CCCI）致非痴呆性血管性认知功能障碍（not-dementia vascular cognitive impairment,NVCI）患者神经心理学及事件相关电位（ERP）P300成分的特点。方法：对52例CCCI致NVCI患者（NVCI组）及30例健康体检者（正常对照组）进行ERP检查,使用简易智能量表（MMSE）、蒙特利尔认知评估量表（MoCA）评定入选者认知功能状态,并进行相关分析。结果：与对照组比较,NVCI组患者的MMSE、MoCA评分明显降低,差异有统计学意义（P〈0．01）,MMSE、MoCA评分与P300潜伏期呈负相关。结论：MMSE、MoCA和P300对于CCCI致NVCI的诊断具有临床指导意义。     

蒙特利尔认知评估量表在成都市社区老年人轻度认知功能障碍筛查中的应用分析

目的:本文旨在研究蒙特利尔认知评估量表(MoCA)在成都市社区老年人轻度认知功能障碍(MCI)筛查中的价值,探讨该量表对社区老年人MCI筛查的最佳分界值。方法:采用简易精神状态量表(MMSE)和MoCA对成都市社区老年人进行MCI筛查,计算MoCA的信度、效度、敏感性、特异性和Youden指数,并计算适合本市老年人MCI患者的划界分。结果:参与此次社区调查并配合完成所有测试的人数为674人,其中MCI患者106人,MoCA量表的Cronbach’sα为0.852;其总分与MMSE相关系数为0.9392;MoCA以原版推荐26分为界,对MCI筛查的敏感性和特异性分别为98.11%和26.72%,Youden指数为0.2483。结论:用MoCA对成都市社区老年人认知功能的筛查是简便可行的,具有良好的信度、效度和敏感性。推荐以22分作为我市社区老年人的MCI分界值。     

晚发型抑郁症伴轻度认知损害患者脑白质胆碱能通路的对照研究

目的：对伴轻度认知损害（ MCI）的晚发型抑郁症（ LOD）患者脑白质胆碱能通路的改变进行对照性研究,并分析其与患者认知功能各领域受损的关系。方法：对伴MCI的LOD患者（研究组,n＝25）磁共振成像的胆碱能通路高信号评分（ CHIPS）,同时评定蒙特利尔认知评估量表（ MoCA）,分析CHIPS评分与MoCA各认知领域的关系;并与不伴MCI的LOD患者（对照组,n＝25）进行对照。结果：①研究组MoCA总分、视空间与执行功能、延迟记忆、注意及工作记忆得分,均显著低于对照组,差异有统计学意义（t＝2．091～2．398,P＝0．041～0．028）;②研究组CHIPS显著高于对照组,差异有统计学意义（t＝2．097,P＝0．042）;③研究组CHIPS评分与MoCA总分、视空间与执行功能、延迟记忆得分显著负相关（r＝－0．434,－0．398,－0．483;P＜0．05）。结论：脑白质胆碱能通路受损,在LOD患者MCI的发生中可能起了一定的作用,尤其与其视空间与执行功能、记忆及延迟记忆的损害有关。     

阻塞性睡眠呼吸暂停综合征患者轻度认知功能障碍的MoCA评估

目的 探讨简易精神状态检查量表(MMSE)、蒙特列尔认知评估量表(MoCA)评估阻塞性睡眠呼吸暂停综合征(OSAS)患者轻度认知功能障碍(MCI)的可行性.方法 用便携式多导睡眠仪、MMSE及MoCA对51名OSAS患者和35名单纯鼾症者进行睡眠监测和认知功能的评价.结果 OSAS组MoCA评分结果为21.1 ±3.0,显著低于对照组的25.0 ±2.6(P＜0.01);MMSE评分结果在OSAS组与对照组中分别为27.8±1.8及28.1±1.7,无统计学意义.结论 MoCA对于OSAS患者MCI的早期诊断敏感性优于MMSE,对于MMSE测试结果正常但高度怀疑存在MCI者,MoCA是一种简便可行的筛查工具.     

太极拳对遗忘型轻度认知功能障碍患者认知功能影响的研究

目的 探讨太极拳对遗忘型轻度认知功能障碍（a-MCI）患者认知功能的影响。方法 将62例a-MCI患者随机分为对照组和观察组,每组31例。对照组患者接受常规健康教育,治疗组在此基础上接受太极拳干预治疗。两组患者分别在治疗前、治疗后6个月采用简明精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）以及事件相关电位P300对患者认知功能评价。结果 对照组治疗前后MMSE、MoCA评分分别比较,差异无统计学意义（P＞0.05）;治疗后观察组MMSE、MoCA评分分别为（25.12±4.17）分、     

帕金森病患者认知功能障碍与抑郁和脑白质疏松症的关系

目的：探讨帕金森病（PD）患者的认知功能障碍与抑郁和脑白质疏松症（LA）的关系。方法：采用简易精神状态量表（MMSE）和临床记忆量表（CMS）、汉密尔顿抑郁量表（HAMD）检查70例PD患者及40例健康对照者的认知功能及情感状态，并比较其认知障碍的程度。结果：①PD组、PD合并LA组、抑郁组MMSE及CMS评分除无意义图形再认外均显著低于对照组（P〈0、05～0、01）；②PD合并LA组MMSE及CMS评分均娃著低于无LA组fP〈0．01）；③抑郁组MMSE及CMS评分除无意义图形再认外均显著低于非抑郁组（P〈0．01）；（4）PD合并LA组中度认知功能障碍5例（27．8％），痴呆11例（61.1％）；PD抑郁组中度认知功能障碍6例（17.6％），痴呆13例38．2％）。结论：PD合并LA及伴发抑郁状态者更易产牛认知功能障碍，合并LA组存在较全面而严蘑的认知功能障碍，抑郁组认知功能的损害主要表现为词语记忆的损害。     

老年痴呆患者认知功能障碍的分析

目的：采用MMSE评价AD患者认知功能障的特点。方法：采用MMSE量表对62例AD患者及159例正常老年人进行测评。应用t检验，多元回归分析对MMSE总分，各项得及其影响因素进行分析。结果：痴呆组MMSE总分及各项得分队体命外均显著低于正常对照组（P＜0．05）。轻度痴呆组在时间地点定向，语言即刻记忆，注意和计算，短程记忆、阅读理解，言语表达及图形描述得分析上高于中度痴呆组，差异有统计学显著性（P＜0．05）。受教育程度与MMSE总分，注意和计算，阅读理解及图形描述得分关系密切（P＜0．05），结论：老年性痴呆患者存在普遍的认知损害。受教育程度是影响痴呆患者智能的重要因素。     

轻度认知障碍患者事件相关电位的诊断价值

目的：对轻度认知障碍（MCI）患者进行事件相关电位（ERP）检测,结合简易智能量表（MMSE）综合评价ERP对MCI的诊断价值。方法：将180例受试者分别编入MCI组、痴呆组及正常对照组,均进行听觉及视觉ERP检测,统计分析各组别ERP的特点。结果：MCI组与正常组及痴呆组比较,P300潜伏期和N2-P3以及P2-P3峰间波幅比较差异均有显著意义（P〈0．01）,其异常出现率也有差异。结论：P300可作为反映认知功能变化和作MCI诊断的一个客观的电生理学指标。     

奥拉西坦和吡拉西坦治疗老年脑出血后认知功能障碍的疗效比较

目的 比较奥拉西坦和吡拉西坦治疗老年脑出血后认知功能障碍的疗效。方法 选择2018年2月~2019年2月我院诊治老年脑出血后认知功能障碍患者116例,随机分为对照组和观察组,各58例。对照组采用吡拉西坦治疗,观察组采用奥拉西坦治疗,比较两组治疗前后蒙特利尔认知评估（MoCA）量表、简易智能精神状态检查（MMSE）量表、日常生活活动（ADL）量评分以及临床不良反应。结果 治疗后两组MoCA、MMSE评分均高于治疗前,且观察组高于对照组,差异有统计学意义（P＜0.05）;治疗后两组ADL评分低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）;观察组不良反应发生率为10.34%,与对照组的12.07%比较,差异无统计学意义（P＞0.05）。结论 奥拉西坦可更好的改善脑出血患者认知功能障碍,提高患者日常生活能力,且临床不良反应少,临床应用效果确切。     

齐拉西酮联合小剂量氯氮平对男性难治性精神分裂症患者认知功能的影响

目的：观察齐拉西酮联合小剂量氯氮平对男性难治性精神分裂症患者认知功能的影响及临床疗效、安全性研究。方法：将100例男性难治性精神分裂症患者随机分为两组各50例,治疗组给予齐拉西酮联合小剂量氯氮平治疗,对照组给予氯氮平治疗。两组均于治疗前后采用阳性与阴性症状量表（ PANSS ）、韦氏成人智力量表（ WAIS－RC）、个人与社会功能量表（ PSP）及不良反应发生量表评定认知功能影响及临床疗效与安全性。结果：两组患者在治疗12周后PANSS总分及各因子分均明显下降,且差异具有统计学意义（t＝16．98,P＜0．05）;治疗后,治疗组WAIS－RC评分及PSP评分均显著提高,且两组差异具有统计学意义（t＝4．76,2．54;P＜0．05）;治疗12周后,两组间临床疗效相当,且治疗期间,治疗组不良反应的发生率明显低于对照组,两组差异具有统计学意义（χ2＝4．24,P＜0．05）。结论：齐拉西酮联合小剂量氯氮平治疗男性难治性精神分裂症与单用氯氮平治疗临床疗效相当,但安全性高,且能更好地改善患者的认知功能。     

Cognitive Processes in Cognitive Therapy: Evaluation of the Mechanisms of Change in the Treatment of Depression

A central theoretical principle guiding cognitive therapy is that mediation by cognitive processes is linked to the successful treatment of depression. The most recent review of the literature on this question is over a decade old and was suggestive of cognitive mediation for cognitive therapy, but was not conclusive. Since this review, a number of studies have been published that address cognitive mediation. The mediation hypothesis can be broadly defined as encompassing two related questions: cognitive mediation framed as “are cognitive changes associated with therapeutic improvement,” and cognitive specificity from the perspective of “are changes in cognition specific to cognitive therapy?” This latter question is particularly important when cognitive therapy is compared to pharmacotherapy. This article reviews the current literature associated with these questions. Our review indicates that the current body of research generally supports cognitive mediation, but is considerably more mixed for cognitive specificity. However, some evidence suggests that cognitive changes associated with pharmacotherapy are more superficial than those associated with cognitive therapy.     

脑电分析在认知研究中的进展

通过脑电分析来认识脑的活动是一种有效的无创手段。近年来,随着认知科学研究的逐渐升温,将脑电信号分析应用于认知研究成为重要的手段之一。本文在对脑电信号处理方法以及认知研究现状等综述的基础上,重点介绍了脑电分析在认知研究中进展状况。文章指出由于EEG良好的时间分辨率等特性,深入研究EEG对于了解认知和思维过程、揭示大脑工作机理具有重要意义。     

Clarifying the Role of Interpersonal Factors in Depression Chronicity From a Cognitive Perspective

Joiner's article (this issue) is a welcome contribution toward clarifying the role of interpersonal factors underlying depression chronicity. We believe, however, that three issues need to be considered regarding an interpersonal research agenda. First, Joiner's proposal would benefit from a discussion of the evidentiary requirements that risk factors must meet. Second, our reading of the literature suggests that interpersonal processes interact with cognitive processes that involve the activation of depressive knowledge structures and that these processes do meet criteria as a possible causal risk factor. Finally, Joiner's global concept of depression chronicity fails to recognize important differences in the mechanisms underlying each of the phenomena of episode prolongation, relapse induction, and recurrence as well as the changes that might occur in these processes with repeated episodes.     

不同认知条件对考试焦虑者的影响

目的：探讨不同认知条件对考试焦虑者的影响。方法：采用考试焦虑量表、认知干扰问卷和字母变换任务对180名大二焦虑学生进行研究。结果：高考试焦虑者在集中注意条件下的成绩明显高于控制条件下的成绩。高考试焦虑者在控制条件下的成绩明显低于中、低考试焦虑者。放松条件对高考试焦虑者有积极作用，对中、低考试焦虑者有消极作用。高考试焦虑者比中、低考试焦虑者有更多的认知干扰。结论：不同认知条件对不同考试焦虑者有不同的影响。     

Treatment of Depression and Mechanisms of Change: Strengthening the Links Among Theory, Research, and Practice

Greater knowledge of the mechanisms underlying cognitive change in the context of depression is an important goal of current clinical research. The thoughtful review by Garratt, Ingram, Rand, and Sawalani (2007) highlights the wealth of research that has been conducted in this area, while also drawing attention to the many complexities inherent in studying the cognitive mediation hypothesis in cognitive therapy. In this commentary, we use the review by Garratt et al. as a starting point from which to highlight some of the issues that we believe to be imperative to the advancement of knowledge in this field of research. These issues include the need for strong connections between theories of cognitive mediation and depression, the deployment of appropriate research paradigms and methods to advance the field, and the conduct of research in contexts that are relevant to clinical practice.     

精神分裂症患者的认知功能改变的研究

目的：探讨精神分裂症的认知功能损害特点。方法：对21例分裂样精神障碍，26例精神分裂症和22名健康对照组进行威期康星卡片分类测验，词汇流畅测验，联想学习，领悟，相似和数字广度测验，结果：在所有的神经心理测验中，分裂症样精神障碍组和精神分裂症组成绩均显著低于对照组（均P＜0．05），威期 星卡分分类测验与其它各项神经心理测验无明显的相关。结论：精神分裂症患者存在认知功能损害。     

Use of P300 Cognitive Evoked Potentials in the Diagnosis of Impairments of Higher Mental Functions after Cardiac Surgery in Conditions of Cardiopulmonary Bypass

A total of 40 patients with ischemic heart disease undergoing aortocoronary shunting surgery in conditions of cardiopulmonary bypass were studied. Parameters of the P300 cognitive evoked potentials were studied before surgery and 7–9 days after surgery. Neurological and neuropsychological assessments were also performed. The most significant parameters of the P300 potential were found to be the latencies of the P3 and N2 components, increases in which showed positive correlations with the extent of the developing cognitive deficit. Evidence supporting the neuroprotective effects of Trasylol given during surgery was obtained. Patients given Trasylol showed less marked cognitive deficit and smaller changes in P300 parameters. Analysis of the P300 cognitive evoked potential can be recommended for detecting early cognitive dysfunction and assessing the efficacy of neuroprotective therapy in patients undergoing surgery with cardiopulmonary bypass. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 105, No. 2, pp. 51–54, February, 2005.     

认知治疗对偏执型精神分裂症患者恢复期的疗效对照研究

目的：探讨认知治疗对偏执型精神分裂症的治疗效果。方法：将符合ＣＣＭＤ－２偏执型精神分裂症诊断标准的患者６０例随机分为两组，在治疗恢复期时分别给予精神药物治疗配合认知心理治疗及精神药物治疗配合支持性心理治疗，出院后跟踪随访两年比较疗。结果：两组间社会功能缺陷及日常生活能力的比较无显著差异，出院后两年的病情复发率认知治疗组明显低于对照组（ｐ＜０．０５）。病情复发的原因主要为不服从治疗、中断药物治疗所致。结论：认知治疗可提高精神分裂症患者对疾病的认识能力，提高患者服从治疗的依从性，因此可改善远期疗效。     

Rapid Early Response in Cognitive Behavior Therapy: A Commentary

In an earlier article, Ilardi and Craighead (1994) suggested that symptom change in cognitive behavior therapy (CBT) occurs too rapidly to be the product of efforts at cognitive modification. In a subsequent response, Tang and DeRubeis (this issue) point out that considerable attention is paid to just such cognitive strategies during early sessions of CUT and that the typical strategy of providing twice weekly sessions allows ample time for cognitive restructuring. These observations accord nicely with the theory and nature of cognitive therapy, which encourages patients to use their own behaviors to test the accuracy of their beliefs. Moreover, Tang and DeRubeis note that individual response is as likely to be discrete and abrupt as continuous over time. Just why this is so remains unclear, but it may be related to the sudden realization by patients that they can use cognitive theory as a tool to deal more effectively with life's problems.