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.     

缓解期抑郁症患者认知功能特点的随访研究

目的 探讨缓解期抑郁症患者认知功能的特点。方法 以2017 年1 月—2017 年7 月于 沈阳军区总医院首次就诊的抑郁症患者130 例和100 名健康人作为研究对象。采用汉密尔顿抑郁量表 （HAMD）评价抑郁症的严重程度。采用威斯康星卡片分类测试、斯特鲁色词测验、连线测试、词语流畅 性测验和韦氏记忆测验分别对缓解期抑郁症患者的信息处理速度、词语流畅性、工作记忆、认知灵活 性、联接记忆和逻辑记忆等方面进行评估。使用草酸艾司西酞普兰对抑郁症患者进行治疗,治疗前和 治疗6 个月后评价患者的抑郁情绪和认知功能。结果 抑郁症组87 例和健康对照组69 人最终纳入本 研究。治疗前,抑郁症组认知功能明显较健康对照组差,差异有统计学意义（P＜ 0.05）。治疗6 个月后, 根据DSM-5 的标准,75 例抑郁症患者达到抑郁症缓解标准。治疗6 个月后,抑郁症患者HAMD 评分从 （34.52±5.01）分下降至（5.01±2.98）分,差异有统计学意义（F=23.132,P＜ 0.05）,且与健康对照组比较 差异无统计学意义（P=0.689）。抑郁症患者治疗6 个月后,除信息处理速度、词语流畅性外,其他认知功 能（工作记忆、认知灵活性、联接记忆和逻辑记忆即刻/ 延时）均明显改善,差异有统计学意义（P＜ 0.05）。 结论 抑郁症患者发病期会出现认知功能（信息处理速度、词语流畅性、工作记忆、认知灵活性、联接记 忆和逻辑记忆即刻/ 延时）损伤。缓解期时,除信息处理速度、词语流畅性外,其他认知功能均明显改善, 结果提示信息处理速度、词语流畅性可能是抑郁症的内表型,而其他认知因子可能是状态型。     

轻型脑外伤后近期的精神障碍

目的：探讨轻型脑外伤后精神障碍的发生率及其表现形式。方法：以近2年内62例轻型脑外伤患者为研究对象，在脑外伤后近期(平均2个月)对患者的精神状态进行评估。结果：轻型脑外伤所致各类精神障碍共40例，总发生率为64．5％，其中智能障碍14例，癔症及神经症样症状31例，创伤后应激障碍5例，抑郁性障碍4例，记忆障碍及精神病性障碍各2例。结论：轻型脑外伤患者伤后近期内精神障碍的发生率较高，表现形式不一，应引起重视。     

脑外伤患者恢复期的注意障碍

目的探索脑外伤恢复期患者注意的改变及其特征.方法对42例大型医院神经外科住院治疗的脑外伤恢复期患者和42名正常人进行"2,7"划消测验和Strop测验.结果脑外伤患者在标准情况、不相关分心情况和相关分心情况下的划消速度明显低于正常对照组,而精确率无明显差异.进一步比较相关分心情况下划消速度的下降率显示脑外伤患者显著大于正常对照组.Stroop测验显示脑外伤患者读单色字时间、读色块时间和读彩色字颜色时间较正常对照组显著延长,但两组之间错误数无显著性差异.比较两组读彩色字颜色时间的延长率和读彩色字文字时间的延长率,脑外伤患者均显著大于对照组.结论脑外伤后患者的注意力下降.注意的分配受损,抗干扰能力下降,而选择注意相对完整.     

多发性硬化的心理障碍研究

多发性硬化患者的心理缺陷发病率很高。记忆及信息处理障碍最常见,智力、注意、视觉——空间及言语能力等认知功能也常有不同程度的损害。精神紊乱以情感障碍特别是抑郁的发病率最高。MRI可观察到临床上“静息”的脑损伤,并能预示认知及精神障碍。     

胎脑组织移植对额叶皮层损伤大鼠辨别学习、记忆之影响

本研究观察了胎脑组织移植对双侧额叶皮层损伤的大鼠学习、记忆功能的影响。学习、记忆再现测验在Y型迷宫中进行。结果表明,胎脑组织移植能促进双侧额叶皮层受损动物明—暗分辨学习及记忆再现功能的恢复,且移植时间长短与其功能恢复呈正相关。组织学检查表明,移植的胎脑组织不仅存活,且分化良好,移植3、6个月后,与宿主脑界面有部分融合,提示移植脑组织与宿主脑可能有纤维联系形成。     

影响男性长期住院精神分裂症患者注意及记忆力的相关因素分析

目的探讨影响男性长期住院精神分裂症患者注意及记忆功能的相关因素。方法采用重复性成套神经心理状态测验(RBANS)中Stroop色词测验(SCW)、持续操作测验(CPT)、数字序列测验、言语记忆及视觉记忆测验对120名男性长期住院(≥5年)精神分裂症患者进行测查,结果与患者一般资料做Pearson相关分析。结果男性长期住院精神分裂症患者的年龄、起病年龄、住院时间、受教育年限、PANSS总分、阴性症状量表分与注意、记忆损害相关,而总病程、既往住院次数、苯海索的使用以及阳性量表分、一般精神病理学分、家族史与注意、记忆损害无明显相关。结论男性慢性精神分裂症患者的注意、记忆损害受多种因素影响,患者症状越重,注意、记忆功能受损越重,尤其阴性症状影响明显,同时,年龄偏大,起病年龄低,文化程度低,住院时间长均影响精神分裂症患者的注意、记忆功能,应该引起临床关注。     

轻度颅脑损伤患者执行功能障碍研究

目的探讨轻度颅脑损伤(mild traumatic brain injury,m TBI)患者伤后执行功能(executive function,EF)的动态变化特点。方法对63例m TBI患者(研究组)在伤后1周、1个月、3个月和6个月进行执行功能测查,并与60例健康受试者(对照组)比较。测查工具采用连线测验(trail making test,TMTA)、霍普金斯词语学习测验修订版(Hopkins verbal learning test-revised,HVLT-R)、简易视觉记忆测验—修订版(brief visuospatial memory test-revised,BVMT-R)、Stroop色词测验、持续操作测验(continuous performance test,CPT)。结果伤后1周与对照组比较,TMTA、HVLT-R、BVMT-R、Stroop和CPT-IP分值差异有统计学意义(P0.05);与伤后1周相比,伤后1个月、3个月和6个月时的TMTA分值下降,HVLT-R、BVMT-R、Stroop和CPT-IP分值增加(P0.05)。组内两两比较,伤后1个月与伤后1周比较,TMTA分值下降,BVMT-R、Stroop分值增加(P0.05);伤后3个月与伤后1个月比较,Stroop、BVMT-R和CPT-IP分值增加(P0.05);伤后6个月与伤后3个月比较,Stroop和CPTIP分值增加(P0.05)。结论m TBI患者在注意能力/警觉性、学习与工作记忆、信息处理速度及执行功能上都可能存在一定的损害,伤后不同时间点恢复速度并不一致。     

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.     

222例精神分裂症患者语词记忆能力的分析

研究精神分裂症患者语词记忆能力。方法采用选择性提醒测验对２２２例精神分裂症患者和２００例正常人的语词记忆进行测验。结果精神分裂症患者存在记忆障碍，并有联想回忆减少和插入增多的特点。结论精神症状有明显加重记忆障碍的作用，而病型、病程及抗精神病药物的剂量等因素对记忆的影响不大。     

Prospective evaluation of first and last memory reports following moderate to severe traumatic brain injury

Prospective monitoring of posttraumatic amnesia (PTA) status is recommended following traumatic brain injury (TBI). Use of patients’ subjective reports is, however, still common and necessary in some circumstances. It is therefore important to understand how patients’ self-reported first memories relate to prospective measures and how reliable these reports remain over time. In the present study, patients with moderate–severe TBI in PTA were asked about their first and last memories surrounding the injury daily and were administered the Westmead Post-Traumatic Amnesia Scale (WPTAS). Following PTA emergence, a semistructured interview was used to ascertain participants’ reports of return of continuous memory after the injury, as well as their last preinjury memory. This interview was repeated six months later, along with the Community Integration Questionnaire to measure functional outcome and the Rey Auditory Verbal Learning Test to measure anterograde memory. The temporal order of recovery of WPTAS variables and subjective reports was determined, and consistency of subjective reports over time was examined using bivariate correlation and intraclass correlation coefficients (ICCs). Findings suggested that patients’ reports of return of continuous memory aligned most closely with return of consistent orientation, and occurred significantly earlier than attainment of criterion on the WPTAS. Reported first memories were significantly later at follow-up (i.e., greater days post injury) and the ICC was not suggestive of adequate clinical reliability. Last memory reports were slightly more reliable, with 71% of cases remaining in the same band at follow-up. Demographic and injury-related variables were not significantly associated with the discrepancy between reports. The variability in patients’ reports over time highlights the importance and value of prospective PTA monitoring.     

The effect of stimulus presentation rate on syntax test performance in brain-injured adolescents

Abstract

The purpose of this study was to explore how testing procedure influences performance after traumatic brain injury, and how this influence varies as a function of the subject's information-processing abilities. Twelve brain-injured subjects completed three versions of the Listening/Grammar subtest of the Test of Adolescent Language. In the first condition, sentences were presented at 2-s intervals, in the second at 4-s intervals, and in the third at variable intervals controlled by the subject. Scores in each condition were correlated with measures of working memory strorage and processing ability. Performance in the 2-s condition was significantly influenced by working memory processing ability, whereas performance in the 4-s condition was significantly influenced by working memory storage ability. Both aspects of working memory contributed to performance in the variable condition, although only processing was significant. As a group, subjects with better working memory processing ability preferred the variable interval condition, which allowed greater flexibility, while subjects with poor processing ability found it more difficult. The results are discussed in terms of clinical assessment and intervention.     

Differential Impairments of Spatial Memory and Social Behavior in Two Models of Limbic Epilepsy

Summary: To explore memory impairments in temporal lobe epilepsy, we used two experimental models in the rats: (a) kainate-induced status epilepticus (SE) resulting in excitotoxic damage and in later spontaneous seizures; and (b) amygdala kindling, known to induce no lesions (or only minor) and neuronal reorganization. Long-term effects of these models on memory were investigated with a spatial learning task in a radial-arm maze, and a social interaction test that implies degree of short-term memory. An histological analysis was made to determine neuronal damage or loss caused by epileptic activity in brain regions that could be related to memory functions. Kainate-induced epilepsy produced large memory deficits in animals tested 5 months after the injection. The rats showed severe lesions in amygdala and hippocampus and piriform and entorhinal cortex. Spatial memory was strongly diminished. The social memory test was severely impaired, probably due to the extent of amygdala injury, which is known to disturb social behavior. On the contrary, kindled rats showed no evident lesion in any brain region and displayed performances as good as those of controls in both tests. These experiments demonstrated that memory deficits appear to be related to the severity of neuronal damage in limbic areas, and the ability to develop seizures (permanence) is not solely responsible for these memory disturbances.     

Effect of the dopamine D2 receptor T allele on response latency after mild traumatic brain injury

OBJECTIVE: The authors tested the hypothesis that the dopamine D2 receptor T allele (formerly described as the A1 allele) would be associated with poorer performance on memory and attention tasks following mild traumatic brain injury. METHOD: Thirty-nine patients with mild traumatic brain injury and 27 comparison subjects were genotyped. All subjects completed memory and attention tests, including the California Verbal Learning Test recognition task and the Continuous Performance Test. RESULTS: In both groups the T allele was associated with poorer performance on the California Verbal Learning Test recognition task. There was also a significant diagnosis-by-allele interaction on measures of response latency (Continuous Performance Test): the subjects with mild traumatic brain injury and the T allele had the worst performance. CONCLUSIONS: Genetic polymorphisms modulating central dopaminergic tone can affect cognitive outcome following mild traumatic brain injury.     

Brain activation during working memory 1 month after mild traumatic brain injury: a functional MRI study.

OBJECTIVE: To assess patterns of regional brain activation in response to varying working memory loads shortly after mild traumatic brain injury (MTBI). BACKGROUND: Many individuals complain of memory difficulty shortly after MTBI. Memory performance in these individuals can be normal despite these complaints. METHODS: Brain activation patterns in response to a working memory task (auditory n-back) were assessed with functional MRI in 12 MTBI patients within 1 month of their injury and in 11 healthy control subjects. RESULTS: Brain activation patterns differed between MTBI patients and control subjects in response to increasing working memory processing loads. Maximum intensity projections of statistical parametric maps in control subjects showed bifrontal and biparietal activation in response to a low processing load, with little additional increase in activation associated with the high load task. MTBI patients showed some activation during the low processing load task but significantly increased activation during the high load condition, particularly in the right parietal and right dorsolateral frontal regions. Task performance did not differ significantly between groups. CONCLUSION: MTBI patients differed from control subjects in activation pattern of working memory circuitry in response to different processing loads, despite similar task performance. This suggests that injury-related changes in ability to activate or to modulate working memory processing resources may underlie some of the memory complaints after MTBI.     

Specific cognitive deficits are common in children with Duchenne muscular dystrophy

A neuropsychological assessment was conducted to study cognition, with emphasis on memory, information processing/learning ability, and executive functions in boys with Duchenne muscular dystrophy (DMD). A group of 20 boys with DMD, aged 7 to 14 years (mean age 9 years 5 months, SD 2 years 2 months), was contrasted with 17 normally developing age-matched comparison individuals, using specific neuropsychological tests (Block Span, Digit Span, Story Recall, Rey Auditory Verbal Learning Test, Rey Complex Figure Test, Spatial Learning Test, Verbal Fluency, Trail Making Test, Tower of London, Memory for Faces, and Raven's Coloured Progressive Matrices). The DMD group performed significantly worse on all aspects of memory, learning, and executive functions. There was no significant difference in general intellectual ability between the two groups. Analyses of group differences indicate that problems in short-term memory are the most apparent, suggesting specific cognitive deficits. The differences between the groups were similar for both verbal-auditory and visuospatial tests, thus contradicting the idea that cognitive deficits are related to type of stimulus presented. It is concluded from this study that short-term memory deficits might play a critical role in the cognitive impairment and intellectual development seen in those with DMD.     

A neuropsychological investigation of prefrontal cortex involvement in acute mania

OBJECTIVE: Mania has received little attention from a contemporary neuropsychological perspective despite its clear resemblance to the disinhibition syndrome sometimes seen after frontal brain injury, particularly injury to the inferior aspect of the prefrontal cortex. The purpose of this investigation was to describe the neuropsychological profile of severe acute mania by using a range of tasks selected primarily for the detection of localized neural disruption within the prefrontal cortex. METHOD: Fifteen acutely manic inpatients were compared with 30 nonpsychiatric subjects on tasks from the Cambridge Automated Neuropsychological Test Battery (Tower of London, spatial working memory, intradimensional-extradimensional attentional shift, and rapid visual information processing tasks) and on the Iowa Gambling Task, Stroop Color and Word Test, a verbal fluency task, and the California Verbal Learning Test. RESULTS: Discriminant function analysis identified deficits in sustained attention (on the rapid visual information processing task) and verbal learning (on the California Verbal Learning Test) as the best indicators of manic performance, rather than deficits on any of the tests of executive functioning. The model correctly classified 91% of subjects overall and 87% of manic subjects. Manic patients did not resemble patients with ventromedial prefrontal cortex damage in their performance on the Iowa Gambling Task. CONCLUSIONS: Acute mania is characterized by core deficits in verbal memory and sustained attention against a background of milder impairments in functions that are traditional measures of prefrontal cortex integrity (attentional set shifting, planning, working memory). The data do not implicate ventral prefrontal cortex disruption as a locus of pathology in acute mania. Verbal memory and sustained attention deficits may relate differentially to the state and trait characteristics of bipolar disorder.     

The impact of early unilateral brain injury on perceptual organization and visual memory.

Studies of young children with early unilateral brain injury have suggested that while hemispheric differences in visuospatial processing appear to be present early in development, the young brain is better able to compensate for injury than when the injury occurs later, after networks have been established. The aim of this study was to determine if this pattern continues later in development when these children are given a challenging task: the Rey-Osterrieth Complex Figure. Experiment 1 included longitudinal data from ten children with early left hemisphere (LH) injury and nine children with early right hemisphere (RH) injury. Injury was presumed to be due to a prenatal or perinatal stroke. Compared with typically developing children, both groups were poorer in copying the figure. With development, these children produced reasonably accurate drawings but continued to use the most immature and piecemeal strategy. In Experiment 2, copy and immediate memory drawings from the 19 children with early unilateral brain injury were collected at a single age (11-14 years). Eight of the ten children with LH injury organized their memory reproductions around the core rectangle but included relatively few additional details. In contrast, only two of the nine children with RH injury organized their memory reproductions around the core rectangle and all but one produced the figure in a piecemeal manner. The results from both studies demonstrate the continuation of subtle deficits in visuospatial analysis with development but also the continued capacity for compensation.     

多奈哌齐与安慰剂治疗脑外伤后记忆障碍的对照研究

目的　探讨多奈哌齐治疗脑外伤后记忆障碍的有效性和安全性。方法　对59 例脑外伤病人随机分成两组,分别给予口服多奈哌齐与安慰剂治疗6个月,采用WMS评价临床疗效,定期查体和实验室检查评价药物不良反应。结果　治疗后多奈哌齐组WMS各项评分均有显著提高(P<0.01~0.05),与安慰剂比较,WMS评分长时记忆、瞬时记忆、记忆商有统计学差异(P<0.05)。口服多奈哌齐未见严重药物不良反应。结论　多奈哌齐治疗脑外伤后记忆障碍有效,安全性好。。     

A longitudinal study of the evolution of cognitive function and affective state in patients with amyotrophic lateral sclerosis.

OBJECTIVES: The study aimed to evaluate cognitive function and emotional reactivity in 18 patients with ALS, compared to 19 matched controls, and assess their evolution over a 12-month period. METHODS: 18 ALS patients and 19 matched controls were included, and assessed at inclusion, six months and twelve months later. Depression was evaluated with the Geriatric Depression Scale, and cognitive function with the Folstein Mini Mental State. A battery of psychometric tests (Wisconsin Card Sorting Test (WCST), the numerical Empan test, the Trail-making test, the Boston Naming Test, the 15-word Rey memory test, the Benton visual retention test and the Raven Progressive Matrix) was used to measure frontal processing and non-frontal function. Emotional reactivity was measured with the film-evoked emotions test. RESULTS: ALS patients were significantly more depressed than controls, as measured on the Geriatric Depression Scale, and depression increased over the study period. There was a very mild defect in cognitive function, and a performance deficit in the Trail-making test, a measure of frontal processing. These deficits, unlike neuromuscular function and depression, did not aggravate over the 12 months of the study. There was no observable change in non-frontal function. Emotional reactivity did not differ significantly between ALS patients and controls. CONCLUSIONS: This study provides further evidence for a mild defect in frontal cognitive processing in ALS patients that evolves only slowly, if at all, with time.