遗忘型轻度认知损害患者和非痴呆血管性认知的损害患者认知功能比较

目的:探讨遗忘型轻度认知损害(amnestic mild cognitive impairment, aMCI)和非痴呆血管性认知损害(vascular cognitive impairment-no dementia, VCI-ND)的认知缺损的特征.方法:本研究为病例对照研究.2006年10月至2007年3月在本院神经内科"记忆障碍"或"中风"门诊选取遗忘型轻度认知损害者10人、非痴呆血管性认知损害者12人,在社区退休老人中随机抽取16人为正常对照组.所有受试年龄在50～80岁之间,教育程度在初中及初中以上,全部完成头颅CT或核磁共振、简易精神状态量表(Mini-mental State Examination, MMSE)及成套神经心理测验.结果:三种记忆测验中,aMCI组各项记忆得分均为最低,aMCI组和VCI-ND组各项得分均低于正常对照组[如,复杂图形测验延迟回忆:正常组(18.8±9.5)、aMCI组(5.6±5.6)、VCI-ND 组(9.6±7.0),P<0.01].执行功能测验中,反应耗时数测验VCI-ND组完成时间为最长,其次是aMCI组[如,连线测验B的耗时数:两组得分分别为 (266.6±109.9)、(199.2±48.6),P=0.034];而反应正确数测验VCI-ND和aMCI组表现均较正常组差[如,Stroop色词测验卡片C正确数正常组(46.8±2.9)、aMCI组(38.7±11.6)、VCI-ND 组(38.3±6.8),P<0.01].结论:遗忘型轻度认知损害患者以情景记忆损害为较早出现严重的认知损害,而非痴呆血管性认知损害患者以执行功能的定势转移障碍为主.这个结果反映了两者在病理机制上的差异.     

Boston命名测验在识别轻度认知损害和阿尔茨海默病中的作用

目的观察Boston命名测验(Boston Naming Test,BNT)30项版本在中国的适用状况和对于遗忘型轻度认知损害(aMCI)与阿尔茨海默病(AD)的识别作用。方法应用BNT(中文版)、简明精神状态量表(MMSE)和听觉词语记忆测验等神经心理测验评估100名社区正常老人、38名MCI、34名轻度AD和38名中度AD患者,4组被试的MMSE总分分别为28.4±1.5、26.1±2.6、20.7±1.7和15.6±3.3。结果正常老人的BNT的自发命名得分与年龄、性别和受教育程度显著相关。正常老人组、aMCI组、轻度AD组和中度AD组自发命名得分分别为24.9±3.0、20.9±3.6、18.7±4.0和15.7±4.2分。以BNT自发命名≤22分作为划界分,识别aMCI的敏感性为61%,识别轻度AD的敏感性为79%,识别中度AD的敏感性为95%,特异性均为81%。提示命名、选择命名能力在aMCI和轻中度AD患者中也呈现进行性损害,但比自发命名能力的下降轻得多。结论正常老人的命名能力受到其年龄、性别和教育程度的影响,aMCI和早期AD患者存在命名能力损害。     

脑卒中后血管性认知功能损害的临床观察

目的:对脑卒中后血管性认知功能损害的情况及治疗效果进行初步观察。方法:采用开放、自身前后对照研究方法,比较简易智能量表(MMSE)对49例脑卒中后患者进行治疗及血管性认知功能测试。结果:随访49例,有不同程度认知障碍者39例(79.6%),其中30例为轻度认知障碍(76.9%)。治疗前MMSE(25.41±3.10)分,治疗后4周及12周时MMSE分别为(26.84±6.18)分和(28.16±3.60)分,治疗前后MMSE分值差异有高度显著性(P<0.001)。结论:脑卒中后1~3个月轻度血管性认知功能损害普遍存在,治疗效果显著。     

轻度认知损害患者的认知保存与缺损特点分析

目的:分析轻度认知损害(MCI)患者的认知保存与缺损的特征.方法:应用Mattis痴呆评定量表(DRS)中文版和简易智能状态检查(MMSE)评定正常老人88例、MCI患者23例和轻度阿尔茨海默病(AD)患者22例.结果:MCI组与正常老人组比较,"记忆"因子有显著减退,而"注意"、"起始/持续"、"结构"和"概念化"四个因子分差异有显著性.与轻度AD组相比,MCI组在总体智力、记忆功能、言语流畅性、执行功能方面的表现明显好于轻度AD患者.结论:上述结果初步反映了MCI的认知保持与缺损特征.     

米氮平治疗脑卒中后抑郁的随机对照研究

一些文献报道脑卒中后抑郁影响脑卒中患者缺损神经功能的恢复及生活质量，因而对脑卒中后抑郁的患者进行有效、可行的抗抑郁治疗很有必要。米氮平为一种新型抗抑郁剂，疗效肯定，不良反应少，但目前国内外用于治疗脑卒中后抑郁的文献报道尚少。本文观察了米氮平治疗脑卒中后抑郁的疗效和不良反应，现将结果报告如下。     

年龄相关的认知损害

老年人群中认知损害是非常普遍的现象 ,其中与增龄老化有关的称为年龄相关的认知损害 /下降(ｉｍｐａｉｒｍｅｎｔ/ｄｅｃｌｉｎｅ)。这种认知损害中常常以记忆受损最早或最突出 ,所以又将早期病例称为年龄相关的记忆损害 /下降 ,损害发展到严重时就是痴呆。一般来说 ,所谓年龄相关的认知损害是指介于正常认知和痴呆之间的轻度认知损害而无痴呆者。其中 ,绝大多数患者的特点是认知损害轻微 ,对日常生活影响不大 ,有自知力 ,且进展缓慢 ,呈现相对稳定状态而不会迅速加重发展为痴呆 ,被认为是正常老化[1] 。少数患者除了有记忆受损外 ,还有认…     

儿童期有性受虐史成人女犯的认知损害

目的:探讨成人女犯中有儿童期性受虐(child sexual abuse,CSA)史者的认知损害情况,及其与创伤后应激症状的关系。方法:对成人女犯CSA 受害组(简称CSA 组)21例,对照组21例进行韦氏记忆(WMS)、威斯康星执行功能(WCST)和划消注意测验,并分析其与创伤后应激症状(IES-R)的关系。结果: CSA 组记忆商数(MQ)(85.1±19.2)、长时(25.9±7.4)和短时记忆(55.6±11.3)三项记忆测验分数明显低于对照组(分别为105.6±14.7,t=3.89,P<0.01;34.5±4.7,t=4.48,P<0.01;65.0±7.3,t=3.56,P<0.01)。CSA 组总实验次数(92.2±24.4)和随机错误(44.8±21.6)明显高于对照组(分别为67.9±19.6,t=-3.48,P<0.01;22.3±14.6,t=3. 89,P<0.01)。CSA 组的净分明显低于对照组(分别为131.9±72.4,171.0±45.9,t=2.09,P<0.05)。上述认知损害还与IES-R 总分、各亚症状分呈现相关,均有显著性意义。结论:成人女犯中有儿童期性受虐史者记忆、执行功能和注意力均受到明显的损害,且这种损害与创伤后应激症状有明显的关系。对成人女犯进行创伤事件的筛查、认知康复训练,实属必要。     

颞叶癫痫患者记忆损害的研究

颞叶癫痫 (ＴＬＥ)患者可出现多方面的记忆障碍 ,左右颞叶病变对记忆的影响也不同 ,现将近年来的研究分别介绍如下。1　空间记忆的损害鉴于以往对ＴＬＥ患者空间记忆研究中所测试内容有言语介入或者由于其内容对于受试者来讲抽象、不熟悉等情况 ,出现所得结果不一致 ,为此 ,Ｂａｘ ｅｎｄａｌｅ[1] 等对检查无脑部结构异常的 6 9例术前患者(右ＴＬＥ2 7例 ,左ＴＬＥ32例 )的空间记忆做了全面的测评。结果表明 :右ＴＬＥ组图案学习、复杂图形即时回忆与延迟回忆及图形保留百分比的得分显著低于左ＴＬＥ组 ;右ＴＬＥ组识别图形细节改变较左Ｔ…     

脑卒中后抑郁与血清细胞因子的相关性

目的:探讨血清细胞因子IL-1β、IL-6、TNF-a与脑卒中后抑郁的相关性.方法:采用酶联免疫吸附法(ELISA)对脑梗死(对照组)及脑梗死后抑郁(研究组)患者各32人在脑梗死后第7和28天分别检测血清IL-1β、IL-6及TNF-a水平.结果:对照组患者第7和第28天的IL-1β、IL-6、TNF-a水平差异无统计学意义(P＞0.05).脑卒中后抑郁组第28天的血清IL-1β、IL-6及TNF-a水平显著高于无抑郁的对照组(41.0±4.4/17.6±3.2,13.5±4.1/5.4±2.0,34.5±7.6/20.8±4.3,P＜0.01),亦显著高于研究组发病第7天的血清水平(17.3±3.5,5.7±2.0,21.1±4.3,P＜0.01);脑卒中后重度抑郁组血清IL-1β、IL-6及TNF-a水平(42.6±3.5,18.7±6.3、39.0±6.4)显著高于轻度抑郁组(28.7±2.5,6.8±1.7、26.4±3.2)及中度抑郁组(34.3±2.8,9.9±3.4、31.5±3.5,P＜0.01),中度抑郁组亦高于轻度抑郁组(P＜0.05).结论:IL-1B、IL-6及TNF-a可能在脑卒中后抑郁的发病机理中起着重要作用.     

轻微认知功能损害快速识别方法的初步研究

目的 :分析轻微认知功能损害快速识别方法。方法 :以记忆减退为主诉的 5 5岁以上老人 15 0名 ,接受韦氏智力量表中文修订 (WAIS -RC)和韦氏记忆量表中文修订版 (WMS -RC)评估。其中智商 (IQ)和记忆商 (MQ)均在 85以上 6 3名 ,作为正常老人组 ;IQ在 85以上、MQ为 70～ 84的 33名 ,作为MCI - 1组 ;IQ在 85以上、MQ为 5 5～ 6 9的 2 5名 ,作为MCI - 2组 ;IQ和MQ均在 85以下、临床表现符合DSM -Ⅳ有关阿尔茨海默病的诊断标准的有 2 9例。结果 :图片记忆和心智B得分在 2个MCI组与正常老人组间最具鉴别力。对记忆轻度受损 (MCI -1组 )有重要识别作用的还有视觉再生记忆 ,对记忆较重受损 (MCI - 2组 )有重要识别作用的还有触觉记忆、理解记忆和联想记忆。结论 :图片短时记忆和心智B可以作为临床医师筛选轻微认知功能损害 (MCI)的有效工具。     

学习困难初二学生的工作记忆容量

目的:探讨学习困难初二学生的工作记忆容量。方法:用学习困难量表筛选出初中二年级语文困难26人、数学困难29人、双困难29人和28名对照组初二学生,通过计算机个别测试,所有初二学生均完成言语和空间6项工作记忆任务。结果:四组学生的6项工作记忆任务得分差异均有统计学显著性,对照组得分均高于三类学习困难初二学生。在阅读广度上对照组初二学生得分高于三类学习困难初二学生(3.9±0.6/1.7±0.6、2.9±0.9、1.8±0.6,F=61.37,P=0.000),语文困难和双困难组初二学生得分显著低于数学困难组(P=0.000);在计算广度上对照组得分均高于三类学习困难组(4.5±1.1/3.8±0.8、1.8±0.8、1.8±0.6,F=79.38,P=0.000),语文困难组得分高于数学困难组及双困难组(P=0.000);双困难组的6项工作记忆容量任务得分均低于对照组。结论:学习困难初二学生的工作记忆容量均存在缺陷,不同学习能力组学生的工作记忆容量出现了不同程度的分化,言语工作记忆容量对学习困难初二学生的影响大于空间工作记忆容量的影响。     

注意缺陷多动障碍儿童精神运动功能与记忆能力

目的:探讨注意缺陷多动障碍(Attentiondeficithyperactivitydisorder,ADHD)儿童和正常儿童精神运动功能与记忆能力的差异。方法:采用1:1病例对照研究,对38例ADHD儿童和38例正常儿童进行津医精神运动成套测验(JPB)与韦氏记忆测验(部分内容)。结果:(1)ADHD组儿童JPB连接数字、符号计入及总成绩均低于对照组(51·37±14·19/57·73±7·30,44·29±7·23/49·82±7·31,336·0±42·1/359·3±43·1,t=2·47、4·64、2·55,均P<0·05);(2)ADHD儿童JPB总分显著低于全国大样本常模;(3)ADHD儿童背诵数目测试成绩显著低于对照组(9·21±3·51/11·37±3·57,t=2·61,P<0·05)。结论:ADHD儿童精神运动功能低于正常儿童,在精细运动的准确性、灵活性及协调性等方面均存在问题,其工作记忆能力受到损害。     

精神分裂症患者工作记忆的功能磁共振成像

目的:探讨精神分裂症患者工作记忆受损的中枢机制。方法:采用组块设计,让10名正常对照和20名精神分裂症患者进行数字再认(识记2或5个数字并判断是否出现过)和箭头方向判断(左或右),并同时进行血氧水平依赖对比功能磁共振(BOLD-fMRI)成像。结果:与对照组相比在高、低认知负荷下,精神分裂症患者基底节区(尾状核)激活均增高(P<0.001),左背外侧前额皮层(DLPFC)激活区域有增大趋势。结论:基底节和背外侧前额皮层(DLPFC)功能异常可能是精神分裂症患者工作记忆受损的中枢基础。     

内囊-基底节区卒中后的记忆功能及相关因素

目的 :内囊 -基底节卒中后的记忆功能缺损及影响因素。方法 :选择符合入组条件的内囊 -基底节区卒中患者 40例 ,采用简易智能检查量表 (MMSE)、韦氏记忆量表 (WMS -RC)、听觉词语回忆测验 (AVMT)和情景图片回忆测验 (MPS)。结果 :各种记忆测验的总分与脑萎缩、教育程度及白质异常有显著相关性。在MPS中 ,病灶容积和白质异常在视觉情景图片的记忆编码策略中起主要作用。有脑萎缩的卒中组与无脑萎缩的卒中组比较 ,所有记忆指标均有显著差异 ,没有脑萎缩的卒中组与正常老人匹配组比较其记忆得分仍然具有显著差异。结论 :内囊 -基底节区卒中可致患者记忆减退 ,形成记忆结果的神经结构与形成记忆编码的神经结构可能有差异     

工作记忆测验练习效应的实验研究

目的：确定出消除工作记忆测绘练习效应影响的最少练习遍数。方法：选择4名年龄19－24岁的大生，分别在连续两天的上午8：30－11：30；下午2：3－5：30和晚上7：30－9：30进行多次练习，并收集练习成绩的数据。结果：在实际分析的4名被试数据中，各工作记忆分测绘（两种类型，三种难度水平）中均存在明显的练习效应，练习成绩前后比较均达到了显著性水平（P＜0．05）。结论：（1）练习效应只是影响被试测验成绩变化的因素之一；（2）为了消除正式测验时出现练习效应所导致的自变量混淆，建议正式测绘时六项分测绘的练习遍数均不得少于18遍。     

识字障碍儿童日常记忆研究

目的:研究识字障碍儿童的日常记忆是否存在落后。方法:从情境、面孔、物品及空间记忆四个维度比较30名五年级识字障碍儿童和30名正常儿童日常记忆的表现。结果:1.识字障碍组在自由回忆和线索回忆都比对照组差(如情境测验中,障碍组和对照组儿童自由回忆成绩的均值分别为3.9±0.9和5.8±1.2,t=6.36,P<0.01,线索回忆为7.2±1.0和8.4±1.1,t=2.89,P<0.05,其他分测验中也有类似结果)说明识字障碍儿童在日常记忆中的表现低于正常儿童;2.识字障碍组和对照组都是线索回忆成绩好于自由回忆成绩(如上述情境记忆中,识字障碍组儿童成绩提高更明显3.9±0.9/7.2±1.0,增高3.3分,t=9.50,P<0.01;正常组儿童也有提高,5.8±1.2/8.4±1.1,t=6.13,P<0.01),说明识字障碍儿童的日常记忆更加依赖线索提示,他们落后的原因是提取困难。结论:识字障碍儿童在日常记忆方面存在落后,其落后主要表现在信息的提取上。     

Heritability of Selective Attention and Working Memory in Preschoolers

In this study aspects of selective attention and working memory were tested in a large sample of nearly 6-year old monozygotic and dizygotic twin pairs, using a computerized test battery (Amsterdam Neuropsychological tasks). In the selective attention task the presence of a foil signal (target signal at an irrelevant location) resulted in more false alarms than a non-target signal. In the working memory task an increase in memory load lead to an increase in response times and errors. We analyzed variations in absolute performance parameters (overall speed and accuracy) and relative performance parameters (increase in errors and/or reaction time). The results showed clear familial resemblances on performance. It proved difficult to ascribe these effects to shared genes or to shared environment. An exception was memory search rate, which was clearly heritable.     

Genetic Structure of Spatial and Verbal Working Memory

Working memory (WM) encompasses both short-term memory (storage) and executive functions that play an essential role in all forms of cognition. In this study, the genetic structure of storage and executive functions engaged in both a spatial and verbal WM span task is investigated using a twin sample. The sample consists of 143 monozygotic (MZ) and 93 dizygotic (DZ) Japanese twin pairs, ages 16 to 29 years. In 155 (87 MZ, 62 DZ) of these pairs, cognitive ability scores from the Kyodai Japanese IQ test are also obtained. The phenotypic relationship between WM and cognitive ability is confirmed (r = 0.26–0.44). Individual differences in WM storage and executive functions are found to be significantly influenced by genes, with heritability estimates all moderately high (43%–49%), and estimates for cognitive ability comparable to previous studies (65%). A large part of the genetic variance in storage and executive functions in both spatial and verbal modalities is due to a common genetic factor that accounts for 11% to 43% of the variance. In the reduced sample, this common genetic factor accounts for 64% and 26% of the variance in spatial and verbal cognitive ability, respectively. Additional genetic variance in WM (7%–30%) is due to modality specific factors (spatial and verbal) and a storage specific factor that may be particularly important for the verbal modality. None of the variance in cognitive ability is accounted for by the modality and storage genetic factors, suggesting these may be specific to WM.     

Working memory load-related electroencephalographic parameters can differentiate progressive from stable mild cognitive impairment

Recent studies described several changes of endogenous event-related potentials (ERP) and brain rhythm synchronization during memory activation in patients with Alzheimer's disease (AD). To examine whether memory-related EEG parameters may predict cognitive decline in mild cognitive impairment (MCI), we assessed P200 and N200 latencies as well as beta event-related synchronization (ERS) in 16 elderly controls (EC), 29 MCI cases and 10 patients with AD during the successful performance of a pure attentional detection task as compared with a highly working memory demanding two-back task. At 1 year follow-up, 16 MCI patients showed progressive cognitive decline (PMCI) and 13 remained stable (SMCI). Both P200 and N200 latencies in the two-back task were longer in PMCI and AD cases compared with EC and SMCI cases. During the interval 1000 ms to 1700 ms after stimulus, beta ERS at parietal electrodes was of lower amplitude in PMCI and AD compared with EC and SMCI cases. Univariate models showed that P200, N200 and log% beta values were significantly related to the SMCI/PMCI distinction with areas under the receiver operating characteristic curve of 0.93, 0.78 and 0.72, respectively. The combination of all three EEG hallmarks was the stronger predictor of MCI deterioration with 90% of correctly classified MCI cases. Our data reveal that PMCI and clinically overt AD share the same pattern of working memory-related EEG activation characterized by increased P200-N200 latencies and decreased beta ERS. They also show that P200 latency during the two-back task may be a simple and promising EEG marker of rapid cognitive decline in MCI.     

Organization of Working Memory Processes in Monkeys: The Effects of a Dopamine Receptor Agonist

The effects of the dopamine receptor agonist agroclavin on cognitive processes associated with mechanisms of visual recognition and long-term and working (short-term) memory were studied in delayed visual differentiation and delayed spatial selection tasks in monkeys (rhesus macaques). Measurements made before and after p.o. pharmacological treatment with this agent were used to identify the p.o. dose (5 mg/kg) inducing a significant effect. The psychotropic effect of agroclavin, which induced cognitive dysfunction, was present in all the monkeys studied to one extent or another. Behavioral criteria were: the probability of correct solutions of the visual differentiation task, the probability of refusals to resolve the task, and the time taken for correct motor responses. Despite individual differences in these behavioral characteristics in monkeys, significant changes due to agroclavin were consistently evident in all animals. There was a reduction in the probability of correct solutions, due to worsening of the characteristics of short-term memory; most monkeys showed increases in the numbers of refusals to solve tasks and increases in the time for correct motor responses during these solutions. In fact, all monkeys showed no increases in the number of erroneous solutions in visual differentiation and spatial selection tasks without delays, though in most cases there were increases in the time taken for correct motor reactions and the number of refusals to solve tasks. Data were obtained indicating that the effect of agroclavin was not uniform with respect to different types of visual information. The possible structural-functional organization of processes underlying working memory is discussed on the basis of the conclusion that the behavioral characteristics studied here reflect different components of cognitive processes realized by structures with different functional properties and different locations.