强迫症患者认知功能与病期的关系

目的：探讨强迫症的认知功能障碍与病期的关系。方法：分别用韦氏记忆测验，数字划销测验和威斯康星卡片分类测验评估25例急性强迫症和36例慢性强迫症患者的记忆、注意和执行功能。结果：急性强迫症患者的记忆测验中记图和数字划销测验中第二阶段失误率显著性较慢性强迫症差，其余两组间记忆测验、划销测验和威斯康星卡片分类测验各量表分无显著性差异。结论：强迫症的认知功能与病期无明显相关。     

奎的平和氯丙嗪对精神分裂症认知功能影响的双盲对照研究

目的 :探讨奎的平和氯丙嗪对精神分裂症患者认知功能的影响。方法 :40例精神分裂症患者随机均分为奎的平组和氯丙嗪组 ,在治疗前、治疗后 4、 6周作知识、算术、数字符号、数字广度 (顺、逆 )、木块拼图、瞬时逻辑记忆、视觉再生即刻和延迟、STROOPC测验、词汇流畅、TOH总分 ,计划时间、延迟逻辑记忆、WCST等神经心理测验 ,整个研究过程采用双盲双模拟法。为观察学习效应 ,12例健康者在相同间隔时间作神经心理测验。所得数据用SPSS10 0进行统计分析。结果 :治疗后 ,奎的平组大部分患者神经心理测验成绩提高而氯丙嗪组的测验结果变化不大 ,尤其在注意、执行功能方面。奎的平对精神分裂症患者认知功能的改善作用优于氯丙嗪 (P <0 0 5 )。结论 :奎的平对精神分裂症患者的注意和执行功能有改善作用而氯丙嗪不明显。     

认知训练和自我按摩对老年人认知功能的影响比较

目的:比较认知训练和自我按摩对于社区老年人认知功能的影响。方法:144名长沙市某社区老年人随机分为对照组、认知训练组和自我按摩组,除对照组外,认知训练组和自我按摩组分别接受为期6个月的认知训练和自我按摩训练干预。干预前后分别采用简明精神状态量表(MMSE)、韦氏记忆量表中国修订版(WMS-C)的图片回忆、联想记忆、理解记忆和背数四个分测验测量。结果:MMSE及记忆的四个分测验的时间主效应显著(P<0.05);不同的干预方法在MMSE得分及图片回忆、联想记忆、理解记忆得分变化上存在统计学差异(P<0.05);除图片回忆外,其余指标存在时间和干预方法之间的交互作用(P<0.01)。进一步组间多重比较显示:在MMSE和图片回忆、联想记忆和理解记忆得分上,认知训练组和自我按摩组与对照组间差异均有统计学意义(P<0.01);但认知训练组与自我按摩组间无统计学差异(P>0.05)。结论:认知训练和自我按摩均可有效改善老年人的认知功能,还不能认为这两种干预方法哪种更有效。     

难治性强迫症与非难治性强迫症认知功能比较研究

目的:比较难治性强迫症与非难治性强迫症认知功能差异。方法:采用韦氏记忆量表(WMS)、数字划销测验、威斯康星卡片分类测验(WCST)评估51例难治性强迫症和59例非难治性强迫症的记忆、注意、执行功能。结果:难治性强迫症的长时记忆较非难治性强迫症差,而两组其它记忆因子分及记商、数字划销测验、威斯康星卡片分类测验分差异无统计学意义。结论:难治性强迫症与非难治性强迫症认知功能无显著性差异。     

难治性抑郁症治疗前后认知功能的对照研究

目的比较难治性抑郁症(TRD)患者治疗前后的认知功能变化。方法入组难治性抑郁症患者60例为研究组,60例健康者为正常对照组。使用威斯康星卡片分类(WCST)、韦氏记忆量表(WMS)、字色干扰实验(Stroop Test)、连线实验(Trails)、语言流畅性测试(VF)、画钟实验(Clock Copying)等神经心理测验工具评测患者的认知功能,并进行治疗前后上述指标的比较。结果①基线时,研究组WCST、WMS记忆商数、时空定向、数字顺数、累加、短时记忆、瞬时记忆、Stroop test、Trails、VF、ClockCopying等神经心理测验评分均与正常对照组存在显著性差异(t=-20.06～9.528,P<0.05);②研究组治疗后与基线相比,总应答数、持续错误数、随机错误数、完成分类数、记忆商数、个人经历、时空定向、数字顺数、累加、视觉再认、视觉再生、触觉、理解、倒背数字、Stroop test、Trails、VF、Clock Copying等评分均明显改善(t=-16.20～9.209,P<0.05);③研究组治疗后在总应答数、正确应答数、完成分类数、记忆商数、图片回忆、视觉再认、理解、C-W、VF、Clock Copying等评分与对照组存在显著性差异(t=-3.685～4.835,P<0.05)。结论 TRD患者的认知功能基线时表现脑功能的全面损害,治疗后显著改善,但在注意、短时记忆、工作记忆、干扰抑制、概念形成、认知灵活性等方面的认知功能损害不能完全恢复正常。     

首发精神分裂症患者认知功能与精神症状及疗效的关系

目的：探讨首发精神分裂症患者的认知和功能与精神症状及疗效的关系。方法：对１６４例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗;于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击测试、动作功能测验、手功能协调测验、连线测验Ａ和Ｂ、威斯康星卡片分类测验（ＷＣＳＴ）及词语流畅性测验１１项神经心理测查各一次,并作ＢＰＲＳ、ＳＡＮＳ、功能总体评定量表（ＧＡＦ）一次;治疗１２周末再评定１次上     

老年轻度认知功能损害的认知缺损特点研究

目的 :用成套神经心理测验评价老年轻度认知功能损害的认知特点。方法 :为横断面比较研究。研究对象分为有轻度认知功能损害的老年人 (MCI组 )和认知功能正常的老年人 (对照组 ,NC组 )两组。以世界卫生组织老年认知功能评价成套神经心理测验 (WHO -BCAI)为主要研究工具。结果 :MCI入组 4 3例 ,NC组 5 0例。两组对象的简明智力状态检查 (MMSE)的平均总分为 :MCI组 2 4 .2± 2 .3分 ,NC组 2 7.8± 1.9分 ;韦氏记忆测验的记忆商(MQ)为 :MCI组 6 7.8± 12 .5 ,NC组 94 .8± 9.5。WHO -BCAI测验结果显示 ,两组间听觉词汇学习测验中 6项 ,语言能力测验的命名回忆测验、词汇流畅性测验、小标记测验 ,视觉材料测验的语义联系和推理测验 ,连线测验 ,注销测验中 4项 ,运动测验和空间结构测验的差异分别具有显著性或极显著性 (P <0 .0 5或P <0 .0 1)。逐步判别分析显示 ,词汇学习测验、连线测验、词汇流畅性测验、延迟回忆测验和空间结构测验具有显著性判别意义 ,判别的总正确率为 83.9%。结论 :神经心理测验可以比较敏感地区分MCI和NC ,有助于阿尔茨海默病的早期诊断     

阿立哌唑和奋乃静对首发精神分裂症患者认知功能的影响

目的探讨阿立哌唑和奋乃静对首发精神分裂症患者认知功能的影响。方法 86例首发精神分裂症患者随机均分为阿立哌唑组和奋乃静组,在治疗前和治疗3月后作数字广度(顺、逆)、即刻逻辑记忆、延迟逻辑记忆、即刻视觉记忆、延迟视觉记忆、连线测验A和B、字色混淆测验(Stroop)以及威斯康星卡片分类测验(W CST)等神经心理测验。结果治疗3个月后同组间相比较:阿立哌唑组除视觉记忆外其他各项认知功能指标均有所好转(即刻视觉记忆t=0.029,延迟视觉记忆t=0.032,P均0.05;其余项目t=2.562～4.658,P0.05或P0.01),而奋乃静组在13项认知功能指标中有5项恶化,主要在逻辑记忆(t=2.747和3.290,P均0.01)和执行功能方面(S troopC-W评分t=2.819,P0.01);两组间相比较:阿立哌唑组除视觉记忆外各项认知功能测查结果均明显好于奋乃静组(即刻视觉记忆t=0.093,延迟视觉记忆t=0.048,P均0.05;其余项目t=2.635～5.748,P0.05或P0.01)。结论阿立哌唑对首发精神分裂症患者的认知功能有改善作用,而奋乃静对认知功能的某些领域有损害。     

青少年及成年孤独症谱系障碍患者社交技能训练的疗效

目的:探讨社交技能训练对青少年和成人孤独症谱系障碍(ASD)患者社会交往障碍的疗效。方法:入组符合美国精神障碍诊断与统计手册第5版(DSM-5)ASD诊断标准的12~30岁被试44例,分为训练组(n=22)和对照组(n=22)。对训练组进行为期14周的社交技能训练,训练前(基线)和训练结束(终点)时,对两组患者进行异常行为量表(ABC)和社交反应量表(SRS)的评定以及心理推理任务和执行功能测查任务的评估。结果:训练组终点的ABC总分和社会退缩因子分,SRS总分和社交知觉、社交认知、社交沟通因子分均低于基线(均P<0.05),心理推理的二级错误信念任务的通过率高于基线(P<0.05),执行功能的Rey复杂图形记忆任务中的延迟记忆结构分、延迟记忆细节分高于基线,连线测验中的数字字母连线时间、B测验完成时-A测验完成时短于基线(均P<0.05)。而对照组在终点时,除ABC社会退缩因子外,其余上述项目与基线时相比差异均无统计学意义(均P>0.05)。结论:社交技能训练能够有效改善青少年和成年ASD患者的整体症状和社会交往障碍,还能有效提高青少年和成年ASD患者的心理推理能力和执行功能。     

颞叶癫?患者前颞叶切除术后短期认知变化的侧别及性别差异

目的：对行一侧标准前颞叶切除术（ATL）的颞叶癫?（ATL）患者在术前及术后开展神经心理测试,并进行统计学分析,旨在分析行一侧ATL不同性别患者在认知功能上的短期影响及变化。方法：选择一侧A T L的颞叶癫?患者42例,进行术前和术后6个月的神经心理测试,采用临床记忆测验和多维神经心理测验。结果：①行一侧A T L的42例患者术后6个月神经心理测验分数与术前比较,记忆水平降低,语音加工及语义理解能力提高;②在术前,行左侧ATL的患者记忆商低于行右侧 ATL患者;在术后,行不同侧别ATL的患者语音加工及语义理解能力均有提高,但差异无显著性;③男性与女性患者在术后记忆商数均有下降,但男性患者无论在术前还是术后的记忆商数均较女性低;不同性别患者术后语音加工和语义理解能力等方面均有提高,但女性在术后的语义理解分数的提高上较男性更显著。结论：在侧别方面,行左侧ATL较右侧切除的病人,术后记忆功能在短期内有降低;在性别方面,女性无论是在记忆还是语音加工、语义理解能力等方面均比男性佳。     

A longitudinal study of cognitive performance during pregnancy and new motherhood

Summary This longitudinal study examined the popular belief that cognitive performance is impaired during pregnancy. Both self-report and objective test data on cognitive performance were collected on six occasions from three groups of women at three monthly intervals. Ten women who initially planned a pregnancy, 18 women initially in the first trimester of pregnancy, and 24 non pregnant controls completed the study. At each data collection participants reported their perceptions of current everyday memory, sleep, health, exercise, depression, anxiety and stress levels, and undertook a set of cognitive tests examining vocabulary, reasoning, short term memory, working memory, and semantic memory. A personality test was taken once. The planning group showed a significant increase in reported forgetting during pregnancy, and significantly more variability in sleep patterns than the control group over the test period. However, there were no other differences between groups on self-report or objective test results at any time phase. The personality factor of conscientiousness and level of reported anxiety were significant predictors of reported absentmindedness and forgetting on errands. The reported increase in forgetting in some pregnant women is possibly related to a complex interaction of personality and particular life situations. However, the precise nature of any objective change in memory performance during pregnancy is not yet clear.     

Memory complaints in a community sample aged 60-64 years: associations with cognitive functioning, psychiatric symptoms, medical conditions, APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities

BACKGROUND: Previous research has found that depression is a major cause of memory complaints. However, there is evidence that memory complaints also weakly predict cognitive decline and dementia. The present study examined a range of possible determinants of memory complaints, covering psychiatric and personality factors, medical history, cognitive test performance, and biological risk factors for dementia (APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities). METHOD: A community survey was carried out with 2546 persons aged 60-64 years living in Canberra and Queanbeyan, Australia. Participants were asked about memory problems which interfered with daily life and whether medical help had been sought. A randomly selected subsample of 476 persons was given a brain MRI scan. RESULTS: Participants with memory complaints were found to have poorer memory test performance, more depression and anxiety symptoms, have higher scores on personality traits involving negative affect, and to have worse physical health. Multivariate analyses showed that measures of cognitive performance did not make a unique contribution to the prediction of memory complaints above that of the other categories of predictors. Those with memory complaints did not differ on any of the biological risk factors for dementia. CONCLUSION: In a community sample aged 60-64 years, memory complaints were most closely related to psychiatric symptoms, personality characteristics and poor physical health. There was no evidence of brain changes indicating early dementia.     

Cortisol reactivity and cognitive performance in a continuous mental task paradigm

The after-effects of fatigue or stress on the performance of cognitive tests have been particularly difficult to demonstrate. In this study we examined whether salivary cortisol, used as an index of stress evoked by the continuous performance of mental tasks, reflected individual differences in cognitive performance. In a within-subject experiment in which 24 subjects were exposed to 4 hours of continuous mental activity and to a control session, significantly higher cortisol levels were found during the continuous task session. Cognitive performance was assessed before and after each session. The relevant test parameters involved aspects of verbal memory, concept shifting and divided attention. When subjects were divided into two groups based on the magnitude of individual cortisol responses to the continuous tasks, it was found that the subgroup with higher cortisol responses decreased in attention compared with their attention after the control session. In contrast, the performance of the subgroup with no or lower cortisol responses did not differ between the two sessions. There was no evidence of similar effects on verbal memory or concept shifting.     

Mild cognitive impairment: applicability of research criteria in a memory clinic and characterization of cognitive profile

BACKGROUND: We explored the applicability of recently proposed research criteria for mild cognitive impairment (MCI) in a memory clinic and changes in case definition related to which memory tests are used and the status of general cognitive function in MCI. METHOD: A total of 166 consecutive GP referrals to the Cambridge Memory Clinic underwent comprehensive neuropsychological and psychiatric evaluation. RESULTS: Of 166 cases, 42 were excluded (significant depression 8, established dementia 29 and other disorders 5). Of 124 non-demented, non-depressed patients, 72 fulfilled Petersen's criteria for amnestic MCI based upon verbal memory performance [the Rey Auditory Verbal Learning Test (RAVLT)] and 90 met criteria if performance on verbal and/or non-verbal memory tests [the Rey figure recall or the Paired Associates Learning test (PAL)] was considered. Of the 90 broadly defined MCI cases, only 25 had pure amnesia: other subtle semantic and/or attention deficits were typically present. A further 12 were classed as non-amnestic MCI and 22 as 'worried well'. CONCLUSIONS: Definition of MCI varies considerably dependent upon the tests used for case definition. The majority have other cognitive deficits despite normal performance on the Mini-mental State Examination (MMSE) and intact activities of daily living (ADL) and fit within multi-domain MCI. Pure amnesic MCI is rare.     

Preserved reading and spelling ability in psychotic disorders

Standard scores on tests of intelligence, memory and academic achievement were obtained from individuals with either schizophrenic spectrum disorders, mania, alcohol abuse, antisocial personality disorders or no mental disorder. The three cognitive measures were highly and positively correlated in three groups (normal controls, alcohol abusers and antisocial personality disorders), while in the schizophrenic spectrum and manic groups a pattern of average reading and spelling achievement was contrasted with lower intelligence and memory quotients. It was suggested that reading and spelling ability are more accurate predictors of premorbid ability in psychotic disorders than other psychometric scales. This parallels previous findings with organic dementias and raises questions about possible shared aetiological bases between dementias and psychoses.     

Sensitivity and specificity of neuropsychological tests for mild cognitive impairment,vascular cognitive impairment and Alzheimer's disease

BACKGROUND: Early diagnosis of dementia is important for those who might benefit from treatment. We designed a brief comprehensive neuropsychological test battery to help differentiate control subjects from patients with mild cognitive impairment (MCI) and dementia. METHOD: The battery included tests of memory, attention, executive function, speed, perception and visuospatial skills. It was administered to subjects from the OPTIMA cohort: 51 controls, 29 with MCI, 60 with 'possible' or 'probable' Alzheimer's disease (AD) (NINCDS/ADRDA) and 12 with cerebrovascular disease (CVD). Mann-Whitney U tests were used to compare performance of controls with other diagnostic groups. The sensitivity and specificity of the tests were determined using Receiver Operating Characteristic curve analyses. The effects of age, gender and years of education on test performance were determined with Spearman's rank correlations. RESULTS: The AD group performed worse than controls on all tests except an attention task. The Hopkins Verbal Learning Test and The Placing Test for episodic memory showed significant discriminative capacity between controls and other groups. Attention and processing speed tests discriminated CVD from controls. Category fluency, episodic memory tests and the CLOX test for executive function distinguished MCI from AD. Spearman's correlations showed negative associations between age and processing speed. Years of education affected performance on all tests, except The Placing Test. CONCLUSIONS: Certain neuropsychological tests have been shown to be sensitive and specific in the differential diagnosis of various types of dementia and may prove to be useful for detection of MCI.     

Informant ratings of cognitive decline in old age: validation against change on cognitive tests over 7 to 8 years

BACKGROUND: Informant questionnaires on cognitive decline are increasingly used as screening tests for dementia. Informants can provide a longitudinal perspective that is not possible with cognitive screening tests administered at one point in time. However, there are limited data on the validity of such questionnaires when judged against longitudinal change on cognitive tests. METHODS: A community sample of elderly people aged > or = 70 was assessed on cognitive tests at baseline and after a follow-up of 7-8 years. The participants were given the Mini-Mental State Examination and tests of episodic memory and mental speed. At follow-up, the short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was completed by informants for 287 of the participants. RESULTS: Elderly people who were rated by informants as having moderate or severe decline had declined significantly on cognitive tests. The IQCODE correlated as highly with cognitive test change scores as these change scores correlated with each other. CONCLUSIONS: The IQCODE is a valid way of assessing cognitive decline when assessment can be carried out only at one point in time.     

脑外伤病人记忆功能的康复特点

脑外伤现已成为危害人们健康的主要疾病之一。脑外伤会引起多种认知功能障碍 ,如注意、记忆和语言等 ,其中记忆障碍较为常见。脑外伤后会有一段时间失去意识 ,同时伴有失定向、意识混乱 ,以及情节记忆受损等症状 ,称为创伤后遗忘 (ｐｏｓｔｔｒａｕ ｍａｔｉｃａｍｎｅｓｉａ ,ＰＴＡ) [1- 3] 。ＰＴＡ可以持续几分钟或几个月不等 ,它对于预测脑外伤后认知功能康复的程度等有重要的参考价值 ,ＰＴＡ的持续时间短 ,程度轻 ,其后认知功能的康复就会较好。对ＰＴＡ最简单的评价是询问病人在外伤后能够记起的第一件事 ,以及病人能够记起的外伤前…     

Tests of memory in narcoleptics

This study attempted to evaluate the validity of self-reports of memory deficits in narcoleptics by comparing the scores of these patients with the scores of matched control subjects on standardized tests of memory function. After completing a short interview designed to elicit qualitative information about memory difficulties, 30 narcoleptic subjects and 30 control subjects completed the Wechsler Memory Scale (WMS), Rey-Auditory Verbal Learning Test, the Rey Complex Figure Test, Strub and Black's List of Letters, and the Symbol Digits Modalities Test (SDMT). In addition, the Profile of Mood States (POMS) was used to detect variation in performance due to anxiety or fatigue. Continuous polygraphic recordings were obtained during the testing to detect any changes in alertness. Subjects with narcolepsy experienced more difficulty in maintaining attention than control subjects, as evidenced by significantly more perseveration errors (p less than or equal to 0.01) on Strub and Black's List of Letters. Despite differences in their ability to sustain attention, there were no significant differences between narcoleptic and control subjects on measures of concentration (Digit Span from the WMS, and the SDMT). Furthermore, there was no objective evidence of memory impairment when the scores of narcoleptic and control subjects were compared on standardized tests of immediate and delayed recall, as well as on tests of verbal and visual memory.     

Cognitive function in late versus early postmenopausal stage

OBJECTIVES: There are relatively few studies of cognitive performance in the first few postmenopausal years and insufficient data on whether there is differential decline in different cognitive abilities. The aim of the present analysis was to determine the nature of cognitive decline across a range of functions within a period of 5 years from early to late postmenopausal stage. METHODS: In a cross-sectional study, 189 postmenopausal women, who had experienced a natural menopause, were not taking hormonal medication and had not done so in the previous 12 months, were divided according to their postmenopausal stage into early (stage +1, < or =5 years since the last menstrual period, aged 55.4+/-0.3 years, n=80), or late (stage +2, >5 years since the last menstrual period, aged 59.8+/-0.4 years, n=109) postmenopausal stages. Participants completed a comprehensive battery of tests measuring attention, episodic and semantic memory, planning and mental flexibility. Participants also completed self-ratings of mood, sleepiness and menopausal symptoms. RESULTS: There were no differences between the groups in their performance in tests of attention, verbal fluency or memory. However, in the two tests of executive function (planning and mental flexibility) the women in the late postmenopausal stage performed significantly worse than the women in the early postmenopausal stage. These differences remained significant when effects of age and IQ were taken into account by analyses of covariance. There were no differences between the groups in their ratings of mood or of habitual sleepiness, or of feeling sleepy at the start of testing. However, by the end of testing the women in the late postmenopausal stage rated themselves as feeling sleepier than did the women in the early postmenopausal stage. The group differences in executive function remained significant when these differences in sleepiness were accounted for. CONCLUSIONS: Although there were no differences in attention, verbal fluency and memory, executive function was significantly poorer in the late postmenopausal stage women, suggesting that this aspect of cognition deteriorates more rapidly than other functions. This change was independent of change in age, suggesting that hormonal changes between the early and late postmenopausal stages may be responsible.