早期帕金森病患者语音性语言工作记忆的特点

目的探讨早期帕金森病(PD)患者语音性语言工作记忆损害及其特点。方法仿制并修订了Smith工作记忆检查软件,对临床确诊的早期PD患者和对照组进行音节性和声调性语言工作记忆检查。结果 PD组(24例)音节性语言工作记忆检查成绩[(92.97±5.70)%]较对照组(24例)成绩[(96.09±3.97)%]明显降低,差异有统计学意义(P0.05)。按音节和声调相同与否进行分层分析结果显示,在同音不同凋时PD患者语言工作记忆成绩明显低于对照组(P0.05),且以右侧肢体起病的PD患者正确率较对照组明显降低(P0.05);PD组(30例)声调性语言工作记忆检查成绩[(72.16±10.85)%]较对照组(30例)成绩[(79.48±9.31)%]显著下降,差异有统计学意义(P0.05)。分层分析结果表明,在同音不同调和同调不同音两种情况下,PD患者语言工作记忆成绩明显低于对照组(P0.05),且以右侧肢体起病的PD患者较对照组明显降低(P0.05)。结论早期PD患者音节及声调性语言工作记忆均受损,音节和声调的语言工作记忆可能由同一神经环路加工。右侧肢体起病的PD患者音节与音调工作记忆受损,提示左侧大脑半球在音节和声调工作记忆处理中起重要作用。     

老年遗忘型轻度认知损害患者语言工作记忆损害特点

目的 探讨老年遗忘型轻度认知损害(aMCI)患者语言工作记忆损害的特点及机制.方法 采用语言工作记忆检查软件对30例老年aMCI患者进行视觉语言工作记忆及词语流畅性和数字广度测试等神经心理学检查,并选择30名健康老人作对照.结果 aMCI患者的视觉语义工作记忆测试成绩正确率低于对照组,差异具有统计学意义(79.83%±3.22%与87.00%±1.93%,t=-1.03,P=0.002);视觉语音工作记忆测试成绩也低于对照组,但差异无统计学意义(78.92%±8.60%与86.80%±2.14%,t=-2.34,P=0.060);逆序数字广度测试(1.53±0.86与3.63±0.56,t=-1.23,P=0.027)和词语流畅性测试分值均低于对照组(22.96±2.31与31.53±3.72,t=-1.08,P=0.004),差异具有统计学意义.结论 老年aMCI患者的视觉语义性语言工作记忆受损,语音性语言工作记忆相对保留;逆序数字广度和词语流畅性测试成绩亦显著降低.     

早期帕金森病患者视觉空间翻转能力受损

目的探讨早期帕金森病(Parkinson disease,PD)患者视觉空间翻转能力的损害情况。方法对29例PD患者及29名健康对照者进行空间翻转测试检查,检查图片包括人体左手、右手、左足、右足以及被黑框挡住左灯或右灯的轿车车头图片,所有图片均有6个角度,要求受试者进行左右判断,以正确率作为比较两组成绩的指标。结果在对客体(车)进行翻转测试时,PD组成绩(89.7%±9.3%)与对照组成绩(91.5%±7.2%)差异无统计学意义(t=0.803,P=0.426),在对自体(手)进行翻转时,PD组成绩(82.5%±11.5%)明显差于对照组(91.5%±6.6%)(t=3.681,P=0.001);以左侧肢体起病者在对自体(手)进行翻转时的成绩(80.7%±16.4%)与对照组(91.5%±6.6%)比较无统计学差异(t=-1.817,P=0.109),以右侧肢体起病者对自体(手)进行翻转时的成绩(83.5%±9.6%)明显差于对照组(91.5%±6.6%)(t=-2.979,P=0.007);PD患者的空间翻转能力与MoCA评分呈正相关。结论早期PD患者存在视觉空间翻转能力受损,并且这种损害存在分离现象,即对自体的空间翻转能力受损,对客体的空间翻转能力相对保留;以右侧肢体起病者更易出现自体的空间翻转能力损害;PD患者的空间翻转能力与总体认知状况相关。     

早中期帕金森病患者前瞻性记忆损害的特点

目的 探讨早中期帕金森病(PD)患者前瞻性记忆损害的特点.方法 采用安徽医科大学前瞻性记忆检查方法,对15例早中期PD患者和15名健康对照者进行基于事件的前瞻性记忆(EBPM)和基于时间的前瞻性记忆(TBPM)检查.结果 PD组EBPM的检查成绩明显低于对照组,二者分别为(3.93±2.69)分和(6.00±2.17)分,差异有统计学意义(t=-2.318,P<0.05);PD组与对照组TBPM的检查成绩分别为(3.47±1.96)分和(3.80 ±1.70)分,差异无统计学意义(t=-0.498,P>0.05).结论 早中期PD患者存在EBPM损害,而TBPM相对保留.     

帕金森病患者工作记忆障碍研究

目的　探讨帕金森病 (PD)患者工作记忆状况。方法　仿制并修订了Smith工作记忆检查软件 ,对 6 6例PD患者及 6 0名对照者进行工作记忆检查。结果　早期PD患者视觉空间工作记忆正确率较对照组低 (分别为 82 8%± 12 1%,90 9%± 6 7%) ,差异有显著意义 (t=3 0 76 ,P <0 0 1) ,视觉物体形状工作记忆正确率与对照组相近 (6 9 2 %± 10 9%,72 7%± 8 1%) ,差异无显著意义 (t=1 389,P >0 0 5 ) ;中期PD患者视觉空间与物体形状工作记忆正确率 (分别为 6 9 6 %± 15 6 %,6 3 11%±5 4 %) ,均较对照组低 ,差异有极显著意义 (t=6 399、t=3 377,P <0 0 0 0 1、P <0 0 1) ;中期PD患者视觉空间与物体形状工作记忆正确率均较早期PD患者低 ,差异有显著意义 (t=2 6 14、t =2 140 ,P <0 0 5 ) ;早期PD患者视觉颜色工作记忆正确率与对照组相近 (6 5 1%± 11 4 %,6 9 9%± 10 1%) ,差异无显著意义 (t=1 6 81,P >0 0 5 )。相关性分析发现 ,Hoehn Yahr分级与工作记忆正确率呈负相关。　结论PD患者早期即有视觉空间工作记忆损伤 ,而视觉物体形状工作记忆及颜色工作记忆正常 ,随着疾病进展至中期 ,PD患者视觉空间与物体形状工作记忆均受损伤 ,且程度较早期加重。     

轻度认知功能障碍患者的执行功能和工作记忆研究

目的 了解轻度认知功能障碍(MO)患者的执行功能和工作记忆是否损害及工作记忆损害特点,探讨执行功能对MCI患者的日常生活活动能力(ADL)的影响.方法 运用神经心理学测试的方法对30例MCI患者进行执行功能、工作记忆及其他认知功能检查,同时进行ADL评定,另外选择30名健康老人作为对照组.结果 MCI组的执行功能和工作记忆成绩(分)显著低于对照组,其中数字颜色连线干扰(130.8±58.2)、数字颜色连线B(210.2±81.8)、词汇流畅性测试(8.9±5.4)、视觉客体工作记忆(0.73±0.12)和数字广度(3.4±0.9),除视觉空间工作记忆外,与对照组比较(52.0±13.5、121.0±33.4、16.4±5.4、0.85±9.18、4.2±1.1)差异均有统计学意义(t=7.108、5.159、-4.879、-4.351、-2.544,均P<0.01或P<0.05).用多元逐步回归方法分析执行功能对ADL的影响,结果 客体工作记忆、空间工作记忆和词汇流畅性与ADL的影响相关,而客体工作记忆与ADL的影响有显著相关性(β=-0.720,t=-3.571,P=0.001).结论 MCI患者具有明显的执行功能障碍和工作记忆损害,工作记忆与MCI患者的ADL有良好相关性,而且视觉客体工作记忆与MCI患者的ADL测查具有显著相关性,因此MCI患者的执行功能障碍可能是导致其ADL下降和客体工作记忆损害的主要因素.     

早期帕金森病隐喻理解研究

目的了解早期帕金森病患者是否存在隐喻理解障碍,并探讨帕金森病患者隐喻理解障碍的相关因素。方法设计隐喻理解检查软件对42例帕金森病患者(PD组)及30例健康对照(对照组)进行隐喻理解研究,比较两组间隐喻理解成绩是否存在差别,以及起病侧、疾病分型对隐喻理解成绩的影响。结果帕金森病患者隐喻理解得分低于对照组〔(71.7±10.8)分vs.(81.6±7.7)分,t=4.204,P=0.000〕。病程与隐喻理解成绩呈负相关(r=-0.355,P=0.023)。右侧起病患者隐喻理解得分与左侧起病者比较〔(72.3±13.2)分vs.(70.9±7.9)分,t=0.415,P=0.681〕,以震颤为主型患者隐喻理解得分与强直少动为主型患者比较〔(72.4±10.5)分vs.(70.5±11.4)分,t=0.541,P=0.592〕差异均无统计学意义。结论帕金森病患者可能存在隐喻理解障碍,且该障碍可能随着病程的延长逐渐加重。     

早期未治疗帕金森病患者情绪记忆损害的特点

目的 探讨早期未治疗帕金森病(PD)患者情绪记忆损害的特点。方法 利用标准的情绪图片(包括正性、负性和中性效价)对33例PD患者和31名年龄、性别和教育程度相匹配的健康对照组进行情绪记忆测试。结果 与对照组[负性(13.4±1.4)分]相比,PD组[(8.9±1.0)分]负性情绪效价图片再认成绩差异有统计学意义(t= - 14.87,P＜0.01);PD组正性[(11.8±1.0)分]和中性[(7.9±1.4)分]情绪效价图片再认成绩与对照组[正性(12.4±2.2)分,中性(8.2±1.3)分]比,差异均无统计学意义。结论 早期未治疗PD患者负性效价情绪记忆存在损害,而正性和中性效价情绪记忆相对保留。     

帕金森病患者轻度认知功能损害

目的 探讨帕金森病(PD)患者伴轻度认知功能损害(MCI)即PD-MCI的特征及其相关因素.方法 采用多种量表[MMSE、Hoehn-Yahr分期、Webster评分、PD统一评分量表-运动(UPDRS-motor)及剑桥老年认知检查量表中文版(CAMCOG-C)]评估PD患者的病情严重程度、运动和认知功能;应用Petersen改良标准诊断PD-MCI.结果 89例PD患者中,认知正常(PDCOGNL)56例(63%),PD-MCI 20例(22%),PD痴呆(PDD)13例(15%).PD-MCI组较PDCOGNL组在定向、语言、记忆、注意、执行、思维、知觉等方面均存在明显损害,两组年龄和起病年龄差异无统计学意义,受教育程度差异有统计学意义(PD-MCI:4.4±4.3,PDCOGNL:7.1±4.9;q=3.270,P<0.05);PD-MCI组的年龄、起病年龄及受教育程度较PDD组差异均无统计学意义;而PDD组较PDCOGNL组在年龄、起病年龄、受教育程度等方面差异均有统计学意义(q=-4.913、-4.997、4.740,均P<0.01);3组间病程差异无统计学意义.Hoehn-Yahr分期、Webster评分及UPDRS-motor评分与PD认知功能均存在负相关.结论 PD-MCI是PD认知正常与PDD之间的过渡状态,存在多个区域的认知损害;高龄、起病年龄迟、受教育程度低可能是PD认知损害的危险因素;疾病严重程度及运动功能与PD认知功能存在着负相关.     

帕金森病的眼球跟踪运动特点

目的 定量分析帕金森病(PD)患者眼球跟踪运动的特点,为评价PD患者的前庭功能提供依据.方法 选取30名健康人(对照组)和55例PD患者(PD组)作为受试者,PD组包括静止件震颤起病者31例(静止性震颤组),运动减少起病者23例(运动减少组),混合起病1例.对全部受试者进行眼震电图检杳.比较PD组和对照组跟踪运动增益值(gain,G)的差异,运动减少组和静止性震颤组跟踪运动的差异,PD患者双侧跟踪运动的非对称性和健康对照者的差异.结果 PD患者双侧跟踪运动的增益值(G左:0.79±0.10、G右:0.78±0.11)较对照组(G左:0.86±0.05、G右:0.85±0.06)明显降低(U=394.500、t=3.547,均P<0.01),运动减少组(G左:0.79±0.14、G右:0.75±0.14)与静止性震颤组(G左:0.79±0.06、G右:0.81±0.07)眼球跟踪运动增益值差异无统计学意义(t=-0.100、2.005,均P0.05).病例组左右两侧的跟踪运动非对称性(1.03±0.97)明显大于对照组(0.87±0.86,U=755.500,P<0.05).结论 PD患者眼球跟踪运动速度明显减慢,但不存在类型间的差异,两侧跟踪运动存在不对称性.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.