首发精神分裂症患者听感觉门控P50及认知功能的相关性研究

目的 探讨首发精神分裂症患者听感觉门控P50与威斯康星卡片分类测验之间的相关性.方法 采用配对听觉条件、测试刺激范式及威斯康星卡片分类测验对51名首发精神分裂症患者和51名健康常人进行检测,并进行相关性分析.结果 患者组听感觉门控P50抑制明显高于对照组(P<0.01);威斯康星卡片分类测验结果显示,患者组完成分类数和正确分类数显著低于对照组,而错误数和持续错误数显著高于对照组(P<0.01);患者组听感觉门控P50抑制与威斯康星卡片分类测验指标间无相关性.结论 首发精神分裂症患者存在认知功能损害与额叶功能缺陷,反映出可能存在不同的神经发生机制.     

缺陷型及非缺陷型精神分裂症执行功能障碍的fMRI初步研究

目的比较缺陷型、非缺陷型精神分裂症患者与执行控制功能有关的脑区激活情况,探讨精神分裂症执行功能障碍的表现规律与相应脑机制。方法缺陷型、非缺陷型精神分裂症患者各6名及与之匹配的正常对照组,在执行参量设计的倒数n项实验时进行全脑BOLD-fMRI扫描。数据处理时采用单因素方差分析进行差异检测,分离出激活强度随记忆负荷增加而增强的脑区（执行加工相关脑区）。结果正常组执行加工相关脑区主要为左侧前额叶及顶叶后部皮层,两精神分裂症组前额叶激活体积相对较小,而且涉及更多皮层下结构。其中非缺陷型组双侧前额皮层均显著激活,且背外侧前额叶（BA9/46区）激活数目较正常组明显增多。而缺陷型组无论是前额皮层激活的脑区分布范围还是体积均显著减少于其他两组。结论精神分裂症患者存在以前额叶功能失调为基础的执行功能障碍。不同亚型的患者前额叶功能失调的机制不同：缺陷型患者前额叶可能存在特异性损伤,而非缺陷型患者主要表现为前额叶的生理低效能。     

精神分裂症空间工作记忆任务的fMRI研究

目的采用fMRI技术探讨精神分裂症患者空间工作记忆损害的神经机制。方法收集18例精神分裂症患者和18名正常受试者进行空间n-back任务的fMRI扫描。采用SPM 8进行数据预处理和统计分析,单样本t-检验用于分析两组各自脑激活结果,双样本t-检验用于工作记忆相关脑激活的组间比较。采用FDR方法进行多重比较校正。利用SPSS 17.0软件对工作记忆任务中的行为学结果 (正确率和反应时间)进行组间比较。结果与对照组相比,精神分裂症患者空间工作记忆任务反应时间延长(882.00±50.31)ms,正确率下降(83.60±2.90)%(P0.05)。精神分裂症患者在n-back空间工作记忆任务时所激活的脑区分布与对照组基本一致,主要包括双侧前额皮层、颞顶叶皮层及部分基底核团。但组间比较显示精神分裂症患者多个脑区激活强度及范围明显增加,包括双侧前额皮层背外侧、双侧后顶叶皮层、右侧中央前回、左侧颞中回、右扣带回和双侧小脑(FDR校正,P0.05)。结论执行空间工作记忆任务时精神分裂症患者脑区激活增加,但行为学表现下降,提示患者脑区活动效率低下,可能是工作记忆能力损害的神经基础。     

首发精神分裂症患者认知功能损害与不同精神症状的相关性研究

目的探讨首发精神分裂症患者认知功能损害与不同精神症状的相关性。方法采用病例对照研究,共选取符合入选标准的首发精神分裂症患者149例、正常对照193例,采用重复性成套神经心理状态测验(RBANS)、威斯康星卡片分类测验(WCST)对两组研究对象进行认知功能测试,比较两组认知功能的差异;采用阳性阴性症状量表(PANSS)评定患者的精神症状并分型,采用美国Niclet Bravo脑诱发电位仪对精神分裂症患者进行认知电位P300检测,分析患者RBANS测验总分与PANSS中不同精神症状的相关性,比较不同亚型患者认知电位P300的差异。结果患者组RBANS测试结果各因子分均显著低于对照组(P<0.05);两组WCST各项测量指标比较均有显著性差异(P<0.05);患者组RBANS测试总分与PANSS阴性症状量表中的交谈缺乏自发性和流畅性、情感交流障碍呈显著正相关(r=0.191、0.192,P<0.05);阴性亚型患者与阳性亚型患者认知电位P300波幅比较呈显著性差异(P<0.05)。结论首发精神分裂症患者存在认知功能的损害,其中认知功能损害程度与阴性症状密切相关。     

帕金森病静息状态下纹状体功能连接的fMRI研究

目的应用血氧水平依赖的功能性磁共振成像研究帕金森病(Parkinson's disease,PD)静息状态下功能连接的改变。材料与方法对35例符合PD诊断标准的患者及20名健康者行静息态脑功能性磁共振成像,选双侧纹状体(striaum,STR)为感兴趣区,采用双样本t检验分别比较左侧STR(L-STR)、右侧STR(R-STR)在两组间的脑功能连接的差异。结果 (1)以L-STR为种子点时,PD组右侧前额叶背外侧部、双侧后扣带回皮质、左侧中央前后回、顶下小叶、左侧楔前叶、左侧缘上回等脑区的正连接较正常组减弱(P0.05,Alpha Sim校正),额下回、海马旁回、左侧海马、左侧岛叶正连接增强(P0.05,Alpha Sim校正)。(2)以R-STR为种子点时,PD组右侧前额叶背外侧部、双侧后扣带回皮质等脑区正连接较正常组减弱(P0.05,Alpha Sim校正),右侧舌回、岛叶、海马旁回、双侧海马、左侧丘脑等脑区正连接增强(P0.05,Alpha Sim校正)。结论静息状态下PD患者的脑功能连接网络存在异常。     

静息态功能MRI观察首发轻-中度抑郁症患者默认网络功能连接北大核心CSCD

目的采用静息态功能MRI(rs-fMRI)观察首发轻-中度抑郁症患者默认网络(DMN)功能特点,探讨功能连接异常脑区与临床表现等的相关性。方法采集24例首发轻-中度抑郁症患者(抑郁症组)和22名健康人(对照组)的颅脑rs-fMRI数据。以内侧前额叶皮质(mPFC)及后扣带回皮质(PCC)为种子点,行全脑功能连接分析。采用Pearson相关性分析评价抑郁症组差异脑区功能连接与17项汉密尔顿抑郁量表(HAMD-17)总评分及病程的相关性。结果相比对照组,抑郁症组mPFC与双侧小脑后叶、右侧前扣带回、右侧额下回眶部及左侧楔前叶功能连接减弱(K均>54,P均<0.05),与右侧额下回岛盖部功能连接增强(K>54,P<0.05);抑郁症组PCC与双侧额中回眶部、双侧壳核及左侧额上回背外侧功能连接减弱(K均>54,P均<0.05),与左侧颞中回、双侧角回及右侧楔前叶功能连接增强(K均>54,P均<0.05)。抑郁症患者mPFC与左侧楔前叶间功能连接减弱、PCC与左侧额中回眶部功能连接减弱均与病程呈负相关(r=-0.42、-0.46,P均<0.05);mPFC与右侧前扣带回功能连接减弱与病程呈正相关(r=0.49,P<0.05);功能连接异常脑区均与HAMD-17评分无显著相关(P均>0.05)。结论首发轻-中度抑郁症患者存在DMN内、外脑区功能连接异常,其中部分与病程相关。     

轻度认知障碍患者计算能力的fMRI研究

目的 探讨早期诊断A1zheimer病的方法，以及轻度认知障碍(MCI)患者计算能力损害的脑功能定位。方法 对8例MCI患者和9例正常对照使用神经心理测定和功能磁共振(fMRI)检查相结合的方法，比较两组反应时间、正确率和fMRI的脑激活图。结果 患者的反应时间比对照组延长(退位减法P＞0．05，非退值减法P＜0．05一0．01)，正确率降低(P＜0．01-0．001)。脑激活图显示：患者在左侧前额叶外下部，颞叶外侧和顶叶激活减弱(P＜0．05)，而右侧前额叶外下部激活代偿性增强(P＜0．05)。结论MCI患者的计算功能已有损害。计算功能的fMRI与认知神经心理学的联合研究能为早期诊断AD提供有力的参考依据。     

精神分裂症患者认知功能障碍的对照研究

目的:探讨精神分裂症患者的认知功能障碍情况。方法:对64例精神分裂症患者及53例正常对照组采用Stroop测验、数字符号测验,韦氏成人智力表第三版(WAIS-Ⅲ)符号搜索,定步调连续加法测验,威斯康星卡片分类测验(WCST-64)进行测评,结果用SPSS 16.0进行分析。结果:精神分裂症患者组与正常对照组的Stroop单词、Stroop颜色、Stroop色词、精神分裂症、WAIS-Ⅲ符号搜索总分、定步调连续加法测验尝试数、定步调连续加法测验正确数、WCST完成测试数、WCST正确数、WCST持续错误数、WCST随机错误数、WCST完成分类数等指标比较差异均有统计学意义的差异。结论:精神分裂症患者存在注意、记忆、执行功能、信息加工、抽象能力、概念形成等多方面认知功能障碍的表现。     

轻度认知障碍患者记忆力的功能磁共振研究

目的为探索早期诊断阿尔茨海默病 (AD)的方法 ,将神经心理测定和功能磁共振 (fMRI)检查相结合 ,了解轻度认知障碍 (MCI)患者在记忆方面的脑功能情况。方法 9例MCI患者和 9名正常对照在进行无意义图形记忆和再认时行fMRI检查 ,对反应时间、正确率和fMRI的脑激活图进行比较。结果患者的反应时间比正常对照明显延长 (P <0 0 1) ,正确率显著降低 (P <0 0 0 1)。脑激活图显示 ,与对照相比 ,在记忆编码时 ,患者主要在左侧前额叶背外侧和海马旁回、以及以右侧为主的后部脑区激活减弱 ,记忆提取时 ,在双侧前额叶背外侧 ,左侧海马旁回和前扣带回 ,以及后部脑区激活减弱。结论MCI患者的记忆功能已有损害。记忆功能的fMRI检查与认知神经心理学的联合研究能为早期诊断AD提供有力的参考依据。     

自我角色认同护理干预对首发精神分裂症康复期患者的影响

目的:探讨自我角色认同护理干预对首发精神分裂症康复期患者的影响。方法:选取2018年6月1日~2019年6月1日治疗的86例首发精神分裂症康复期患者为研究对象,按照随机数字表法将其分为观察组和对照组各43例,对照组给予常规护理,观察组在常规护理基础上给予自我角色认同护理干预;比较两组干预前后自我效能[采用一般自我效能量表(GSES)]、病耻感[采用精神疾病内在病耻感量表(ISMI)]及意念功能[采用威斯康星卡片分类测验(WCST)]及服药依从性。结果:干预后,两组GSES评分、WCST中总应答数(Ra)及完成分类数(Cc)评分均高于干预前(P<0.05),且观察组均高于对照组(P<0.05);干预后,两组ISMI评分、WCST中错误应答数(Re)及持续性错误数(Rpe)评分均低于干预前(P<0.05),且观察组均低于对照组(P<0.05);观察组服药依从性高于对照组(P<0.05)。结论:自我角色认同护理干预对首发精神分裂症康复期患者具有较好的效果,能提高患者自我效能及服药依从性,降低病耻感,改善意念功能。     

正常成人执行控制和冲突监测功能磁共振研究

目的采用事件相关功能磁共振成像（ER-fMRI）技术,研究正常成人持续性操作任务（CPT）持续性注意条件状态的脑激活区,探讨持续性注意冲突监测和执行控制的神经基础。方法采用1.5T磁共振成像系统,对16例健康右利手的成人进行了持续性操作任务实验测试,测试任务采用阿拉伯数字0～9,任务分为三种条件：靶（GO）、非靶（NO-GO）和背景数字。采集脑部的血氧水平依赖性-功能性磁共振成像（BOLD-fMRI）数据,通过SPM2软件进行统计学分析,使用非靶（NOGO）和背景数字相减,得到非靶任务脑功能活动的图像。结果①前扣带回（ACC）和左侧背外侧额叶（DLPFC）激活。②脑干、壳核和尾状核激活。结论扣带回和背外侧额叶是执行冲突监控和反应抑制基础,在冲突监测和反应抑制形成反馈环路,实验支持背外侧额叶是执行控制脑区,提示在持续注意状态下,执行反应控制依赖脑干和新纹状体协调。     

Cognitive-Behavioral Therapy Increases Prefrontal Cortex Gray Matter in Patients With Chronic Pain

Several studies have reported reduced cerebral gray matter (GM) volume or density in chronic pain conditions, but there is limited research on the plasticity of the human cortex in response to psychological interventions. We investigated GM changes after cognitive-behavioral therapy (CBT) in patients with chronic pain. We used voxel-based morphometry to compare anatomic magnetic resonance imaging scans of 13 patients with mixed chronic pain types before and after an 11-week CBT treatment and to 13 healthy control participants. CBT led to significant improvements in clinical measures. Patients did not differ from healthy controls in GM anywhere in the brain. After treatment, patients had increased GM in the bilateral dorsolateral prefrontal, posterior parietal, subgenual anterior cingulate/orbitofrontal, and sensorimotor cortices, as well as hippocampus, and reduced GM in supplementary motor area. In most of these areas showing GM increases, GM became significantly higher than in controls. Decreased pain catastrophizing was associated with increased GM in the left dorsolateral prefrontal and ventrolateral prefrontal cortices, right posterior parietal cortex, somatosensory cortex, and pregenual anterior cingulate cortex. Although future studies with additional control groups will be needed to determine the specific roles of CBT on GM and brain function, we propose that increased GM in the prefrontal and posterior parietal cortices reflects greater top-down control over pain and cognitive reappraisal of pain, and that changes in somatosensory cortices reflect alterations in the perception of noxious signals.     

Cognitive modulation of pain-related brain responses depends on behavioral strategy

Interactions of pain and cognition have been studied in humans and animals previously, but the relationship between such behavioral interactions and brain activity is unknown. We aimed to show using functional MRI (fMRI) how a cognitively demanding task (Stroop) modulates pain-related brain activations and conversely, how pain modulates attention-related activity. Reaction time data indicated two types of pain responders: subjects in the A group had a faster Stroop reaction time when pain was concomitant to the attention task, while those in the P group had a slower Stroop performance during painful stimulation. fMRI data obtained during Stroop performance with and without noxious stimulation were subjected to region of interest analyses. We first tested whether brain activity during painful median nerve stimulation was modulated by cognitive load. We next tested whether brain activity during the high conflict cognitive task was modulated by pain. Pain-related activity in three regions, primary (S1), and secondary (S2) somatosensory cortices, and anterior insula, was attenuated by cognitive engagement, but this effect was specific to the A group. Pain-related activations in the caudal and rostral anterior cingulate cortex (ACC) and ventroposterior thalamus were not modulated by cognitive load. None of the areas showing attention-related responses, including bilateral dorsolateral prefrontal and posterior parietal cortices, were modulated by pain. These findings suggest that cortical regions associated with pain can be modulated by cognitive strategies. Furthermore, the distinction of behavioral subgroups may relate to cognitive coping strategies taken by patients with chronic pain.     

基于比率低频振幅fMRI评价青少年网络游戏成瘾者静息态下脑功能活动

目的：采用比率低频振幅（fALFF）评价青少年网络游戏成瘾（IGA）者静息态下脑功能区激活特点.方法：对17例符合IGA诊断标准的青少年（IGA组）及19例在年龄、性别、受教育年限、利手等方面相匹配的青少年健康志愿者（正常对照组）行静息态fMRI扫描,两组间fALFF的差异采用两样本t检验.结果：与正常对照组相比,IGA组静息态下双侧额上回及额中回、右侧额内侧回、右侧扣带回前部及左侧扣带回后部、右侧海马旁回、右侧颞下回、右侧楔前叶脑区fALFF增高,差异有统计学意义（P＜0.05,未校正）.右侧颞上回及颞中回、双侧舌回、双侧枕叶、右侧胼胝体压部及双侧小脑脑区fALFF降低,差异有统计学意义（P＜0.05,未校正）.结论：IGA者静息态下脑功能存在异常,fALFF有助于对IGA者静息状态脑功能变化的理解.     

Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test

The specific role of particular cerebral regions with regard to executive functions remains elusive. We conducted a functional magnetic resonance imaging (fMRI) study to segregate different network components underlying the Wisconsin Card Sorting Test (WCST), a test widely applied clinically to assess executive abilities. Three different test variants of the WCST, differing in task complexity (A > B > C), were contrasted with a high-level baseline condition (HLB). Cognitive subcomponents were extracted in a serial subtraction approach (A-C, A-B, B-C). Imaging data were further subjected to a correlational analysis with individual behavioral parameters. Contrasting A with the HLB revealed the entire neural network underlying WCST performance, including frontoparietal regions and the striatum. Further analysis showed that, within this network, right ventrolateral prefrontal cortex related to simple working memory operations, while right dorsolateral prefrontal cortex related to more complex/manipulative working memory operations. The rostral anterior cingulate cortex (ACC) and the temporoparietal junction bilaterally represented an attentional network for error detection. In contrast, activation of the caudal ACC and the right dorsolateral prefrontal cortex was associated with increased attentional control in the context of increasing demands of working memory and cognitive control. Non-frontal activations were found to be related to (uninstructed relative to instructed) set-shifting (cerebellum) and working memory representations (superior parietal cortex, retrosplenium). The data provide neural correlates for the different cognitive components involved in the WCST. They support a central role of the right dorsolateral prefrontal cortex in executive working memory operations and cognitive control functions but also suggest a functional dissociation of the rostral and caudal ACC in the implementation of attentional control.     

帕金森病静息态脑功能MRI研究

目的：应用血氧水平依赖的功能MRI（BOLD-fMRI）,探索帕金森病（PD）患者静息态脑功能可能存在的异常。材料与方法对68例PD患者和36例健康志愿者进行静息态BOLD-fMRI检查。分析PD组与正常对照组标准化脑功能低频振荡幅度（mALFF）的差异。结果与正常对照组比较,PD组在双侧辅助运动区、中后扣带回、楔前叶、海马、海马旁回、外侧苍白球、背侧丘脑、小脑前叶以及右侧局部初级运动皮层、岛叶、尾状核、壳核、小脑后叶等广泛区域mALFF值显著减低（P〈0.05,AlphaSim校正）,在双侧前额叶、顶叶及颞叶的广泛外侧皮层、左侧枕叶初级视觉皮层等区域mALFF值显著增高（P〈0.05,AlphaSim校正）。结论 PD患者静息态脑功能存在广泛异常,主要表现为PD患者在运动调节相关脑区、默认网络关键节点、边缘系统等部位神经元活动减弱,在前额叶、顶叶、颞叶的广泛外侧皮层以及初级视觉皮层等部位神经元活动增强。     

A temporoparietal and prefrontal network for retrieving the spatial context of lifelike events

Virtual reality (VR) and event-related functional magnetic resonance imaging were used to study memory for the spatial context of controlled but lifelike events. Subjects received a set of objects from two different people in two different places within a VR environment. Memory for the objects, and for where and from whom they were received was tested by putting the subject back into a place in the company of a person and giving a paired forced choice of objects. In four conditions objects had to be chosen according to different criteria: which was received in that place, which was received from that person, which object was recognized, and which object was widest. Event-related functional magnetic resonance imaging was performed during testing to identify areas involved in retrieval of the spatial context of an event. A network of areas was identified consisting of a temporoparietal pathway running between the precuneus and parahippocampi via retrosplenial cortex and the parieto-occipital sulcus, left hippocampus, bilateral posterior parietal, dorsolateral, ventrolateral and anterior prefrontal cortices, and the anterior cingulate. Of these areas the parahippocampal, right posterior parietal, and posteriodorsal medial parietal areas were specifically involved in retrieval of spatial context compared to retrieval of nonspatial context. The posterior activations are consistent with a model of long-term storage of allocentric representations in medial temporal regions with translation to body-centered and head-centered representations computed in right posterior parietal cortex and buffered in the temporoparietal pathway so as to provide an imageable representation in the precuneus. Prefrontal activations are consistent with strategic retrieval processes, including those required to overcome the interference between the highly similar events.     

The human prefrontal and parietal association cortices are involved in NO-GO performances: an event-related fMRI study

One of the important roles of the prefrontal cortex is inhibition of movement. We applied an event-related functional magnetic resonance imaging (fMRI) technique to observe changes in fMRI signals of the entire brain during a GO/NO-GO task to identify the functional fields activated in relation to the NO-GO decision. Eleven normal subjects participated in the study, which consisted of a random series of 30 GO and 30 NO-GO trials. The subjects were instructed to press a mouse button immediately after the GO signal was presented. However, they were instructed not to move when the NO-GO signal was presented. We detected significant changes in MR signals in relation to the preparation phases, GO responses, and NO-GO responses. The activation fields related to the NO-GO responses were located in the bilateral middle frontal cortices, left dorsal premotor area, left posterior intraparietal cortices, and right occipitotemporal area. The fields of activation in relation to the GO responses were found in the left primary sensorimotor, right cerebellar anterior lobule, bilateral thalamus, and the area from the anterior cingulate to the supplementary motor area (SMA). Brain activations related to the preparation phases were identified in the left dorsal premotor, left lateral occipital, right ventral premotor, right fusiform, and the area from the anterior cingulate to the SMA. The results indicate that brain networks consisting of the bilateral prefrontal, intraparietal, and occipitotemporal cortices may play an important role in executing a NO-GO response.     

The large-scale neural network for spatial attention displays multifunctional overlap but differential asymmetry

Functional magnetic resonance imaging (fMRI) was used to determine the brain regions activated by two types of covert visuospatial attentional shifts: one based on exogenous spatial priming and the other on foveally presented cues which endogenously regulated the direction of spatial expectancy. Activations were seen in the cortical and subcortical components of a previously characterized attentional network, namely, the frontal eye fields, posterior parietal cortex, the cingulate gyrus, the putamen, and the thalamus. Additional activations occurred in the anterior insula, dorsolateral prefrontal cortex, temporo-occipital cortex in the middle and inferior temporal gyri, the supplementary motor area, and the cerebellum. Direct comparisons showed a nearly complete overlap in the location of activations resulting from the two tasks. However, the spatial priming task displayed a more pronounced rightward asymmetry of parietal activation, and a conjunction analysis showed that the area of posterior parietal cortex jointly activated by both tasks was more extensive in the right hemisphere. Furthermore, the posterior parietal and temporo-occipital activations were more pronounced in the task of endogenous attentional shifts. The results show that both exogenous (based on spatial priming) and endogenous (based on expectancy cueing) shifts of attention are subserved by a common network of cortical and subcortical regions. However, the differences between the two tasks, especially in the degree of rightward asymmetry, suggests that the pattern of activation within this network may show variations that reflect the specific attributes of the attentional task.