卒中后失语症类型及其影响因素分析

目的 通过探讨性别、年龄、病变部位及卒中病因等与失语症类型之间的关系，探索影响卒中后失
语类型的因素。
方法 回顾性分析2004年1月-2018年12月于首都医科大学附属北京天坛医院就诊、因语言障碍进行
西部失语成套测验（western aphasia battery，WAB）的卒中后失语症患者临床资料。分析失语症类型与
性别、年龄、卒中类型、卒中病因及发病机制之间的关系。
结果 共纳入失语症患者681例，按照失语症类型分为完全性失语（global aphasia，GA）（n =185）、
运动性失语（broca’s aphasia，BA）（n =148）、经皮质混合性失语（mixed transcortical aphasia，MTCA）
（n =30）、经皮质运动性失语（transcortical motor aphasia，TCMA）（n =67）、感觉性失语（werni cke’s
aphasia，WA）（n =69）、经皮质感觉性失语（transcortical sensor aphasia，TCSA）（n =21）、传导性失
语（conduction aphasia，CA）（n =32）和命名性失语（anomic aphasia，NA）（n =129）。将患者分为青年组
（18～44岁）、中年组（45～59岁）、老年组（≥60岁），校正其他因素影响后，三组人群间失语症类型
无统计学差异。男性和女性患者的失语症类型也无统计学差异。各类型失语症患者的病变部位具有
异质性，除合并经典语言区损伤外，还可合并左侧基底节及丘脑损伤。在脑出血所致的各类型失语
症患者中，最常见的病因均为高血压（77.8%～100.0%）。脑梗死后GA患者中，最常见的卒中发病机制
是混合型（42.4%）和动脉-动脉栓塞（27.3%），而BA、WA及CA患者以动脉-动脉栓塞（分别占51.5%，
71.4%和40.0%）最常见，TCMA、TCSA及NA以低灌注/栓子清除能力下降（分别占65.9%，58.3%和
38.4%）最常见。
结论 年龄及性别对失语症类型均无明显影响。男性和女性患者均以GA、BA和NA最为常见。病变
部位对失语症类型具有重要影响，卒中病因及发病机制对失语症类型的影响可能与特定血管及血管
供血区损伤有关。     

卒中急性期叶酸水平对卒中后失语症的影响

目的 研究卒中急性期叶酸水平对卒中后失语症自然恢复情况的影响.方法 74例急性脑卒中后失语患者分别于急性期及卒中后3月采用西部失语成套测验(WAB)及波士顿诊断性失语症检查进行评估.于急性期运用放射免疫分析法检测血清叶酸水平.结果 所有患者卒中后3月语言功能均有不同程度的恢复,叶酸正常组恢复程度更明显.结论 血清叶酸水平对卒中后失语的恢复可能具有一定的影响作用.     

卒中后失语症类型及其影响因素分析

目的 通过探讨性别、年龄、病变部位及卒中病因等与失语症类型之间的关系,探索影响卒中后失 语类型的因素。 方法 回顾性分析2004年1月-2018年12月于首都医科大学附属北京天坛医院就诊、因语言障碍进行 西部失语成套测验（western aphasia battery,WAB）的卒中后失语症患者临床资料。分析失语症类型与 性别、年龄、卒中类型、卒中病因及发病机制之间的关系。 结果 共纳入失语症患者681例,按照失语症类型分为完全性失语（global aphasia,GA）（n =185）、 运动性失语（broca’s aphasia,BA）（n =148）、经皮质混合性失语（mixed transcortical aphasia,MTCA） （n =30）、经皮质运动性失语（transcortical motor aphasia,TCMA）（n =67）、感觉性失语（werni cke’s aphasia,WA）（n =69）、经皮质感觉性失语（transcortical sensor aphasia,TCSA）（n =21）、传导性失 语（conduction aphasia,CA）（n =32）和命名性失语（anomic aphasia,NA）（n =129）。将患者分为青年组 （18～44岁）、中年组（45～59岁）、老年组（≥60岁）,校正其他因素影响后,三组人群间失语症类型 无统计学差异。男性和女性患者的失语症类型也无统计学差异。各类型失语症患者的病变部位具有 异质性,除合并经典语言区损伤外,还可合并左侧基底节及丘脑损伤。在脑出血所致的各类型失语 症患者中,最常见的病因均为高血压（77.8%～100.0%）。脑梗死后GA患者中,最常见的卒中发病机制 是混合型（42.4%）和动脉-动脉栓塞（27.3%）,而BA、WA及CA患者以动脉-动脉栓塞（分别占51.5%, 71.4%和40.0%）最常见,TCMA、TCSA及NA以低灌注/栓子清除能力下降（分别占65.9%,58.3%和 38.4%）最常见。 结论 年龄及性别对失语症类型均无明显影响。男性和女性患者均以GA、BA和NA最为常见。病变 部位对失语症类型具有重要影响,卒中病因及发病机制对失语症类型的影响可能与特定血管及血管 供血区损伤有关。     

卒中后抑郁研究进展

卒中后抑郁(post-stroke depression,PSD)是指有明显临床症状的卒中后引发的抑郁症(相对于静息性脑血管病而言)[1].卒中后抑郁不仅能影响患者的恢复及预后,还能影响患者及家人的生活质量,目前已越来越受到医学界的关注.近年来,关于其流行病学、发病机制、危险因素、康复预后、诊治等方面的研究有很多新的进展.     

卒中-心脏综合征的研究进展

卒中-心脏综合征是指卒中后30 d内发生的心血管并发症，包括急性心肌损伤、急性冠状动脉综合征、心功能不全、心律失常等。相关研究显示，自主神经功能障碍、脑-肠轴损害、炎症等可能是卒中-心脏综合征的发病机制，但其病因及预后仍未阐明。此外，卒中-心脏综合征可能出现心肌梗死、慢性心功能障碍、脑白质病变、认知障碍等各种远期并发症，影响患者的预后。本文综述卒中-心脏综合征的发病机制、远期并发症以及早期风险评估方法的相关研究进展，旨在加深对此病的理解，为未来探寻更恰当的预防和治疗手段提供参考。     

脑卒中后尿失禁发生率、预后及其危险因素的前瞻性研究

目的 前瞻性研究脑卒中后尿失禁发生率、预后及其危险因素。方法急性脑卒中住院患者158名，对患者发病1周和随访3个月的排尿情况及高危因素进行分析。结果发病1周尿失禁患者占42．4%．排尿困难占7．6％，50．0％排尿正常。单因素分析表明高龄、血肿大、伴失语、额叶和丘脑病变、及病情严重的患者易发生尿失禁。Logistic多元回归分析表明失语(OR值9．324，95％可信区间1．94～44．79)；额叶病变(OR值24．6．95％可信区间2．78～216)；基底节病变(OR值6．76，95％可信区间1．0～42)是尿失禁发生的危险因素。3个月存活患者中尿失禁占25．6％，高龄、入院时病情严重，额叶病变患者尿失禁不易恢复。结论高龄、失语、额叶病变、发病1周病情严重程度是影响卒中后尿失禁发生及预后的危险因素。     

卒中后抑郁的流行病学及病因机制研究进展

卒中后抑郁是影响脑卒中预后的重要心理障碍。目前卒中后抑郁的流行病学研究差异较大。同时卒中后抑郁病因学机制还不明确,但主要的观点认为卒中后抑郁是生物学机制和社会心理机制共同作用的结果。本文就卒中后抑郁的流行病学研究现状及发病机制研究进展进行综述。     

医院版卒中失语抑郁问卷的汉化及其应用评价

目的 汉化10条目医院版卒中失语抑郁问卷（stroke aphasic depression questionnaire-hospital version， SADQ-H10），评价该量表在卒中后失语伴抑郁患者中的可接受度、信度和效度，为评价卒中后失语患 者的抑郁提供标准化测量工具。      

卒中后疲劳的研究进展

随着缺血性脑卒中发病率的增加和存活率的提高,卒中后疲劳（PSF）已成为一种常见卒中 后症状。有研究表明至少有一半卒中患者出现卒中后疲劳。现对卒中后疲劳的最新研究进展进行综述, 以了解其概念、发病率以及相关影响因素,并对其复杂的发病机制进行探讨。     

卒中后抑郁的发病机制及危险因素的研究进展

卒中后抑郁（post-stroke depression,PSD）是脑卒中后最常见的神经精神系统并发症。卒中后抑郁会导致包括残疾加重、发病率和死亡率增高等多种不良结果。了解卒中后抑郁的发病机制及危险因素，对卒中后抑郁的诊疗至关重要，期望能为卒中后抑郁的治疗提供新的可能。     

Recent developments in functional and structural imaging of aphasia recovery after stroke

BACKGROUND: Functional and structural neuroimaging techniques can increase our knowledge about the neural processes underlying recovery from post-stroke language impairments (aphasia). AIMS: In the present review we highlight recent developments in neuroimaging research of aphasia recovery. MAIN CONTRIBUTION: We review (a) cross-sectional findings in aphasia with regard to local brain functions and functional connectivity, (b) structural and functional imaging findings using longitudinal (intervention) paradigms, (c) new adjunct treatments that are guided by functional imaging techniques (e.g., electrical brain stimulation) and (d) studies related to the prognosis of language recovery and treatment responsiveness after stroke. CONCLUSIONS: More recent developments in data acquisition and analysis foster better understanding and more realistic modelling of the neural substrates of language recovery after stroke. Moreover, the combination of different neuroimaging protocols can provide converging evidence for neuroplastic brain remodelling during spontaneous and treatment-induced recovery. Researchers are also beginning to use sophisticated imaging analyses to improve accuracy of prognosis, which may eventually improve patient care by allowing for more efficient treatment planning. Brain stimulation techniques offer a new and exciting way to improve the recovery potential after stroke.     

Recent developments in functional and structural imaging of aphasia recovery after stroke

ABSTRACT

Background: Functional and structural neuroimaging techniques can increase our knowledge about the neural processes underlying recovery from post-stroke language impairments (aphasia).

Aims: In the present review we highlight recent developments in neuroimaging research of aphasia recovery.

Main Contribution: We review (a) cross-sectional findings in aphasia with regard to local brain functions and functional connectivity, (b) structural and functional imaging findings using longitudinal (intervention) paradigms, (c) new adjunct treatments that are guided by functional imaging techniques (e.g., electrical brain stimulation) and (d) studies related to the prognosis of language recovery and treatment responsiveness after stroke.

Conclusions: More recent developments in data acquisition and analysis foster better understanding and more realistic modelling of the neural substrates of language recovery after stroke. Moreover, the combination of different neuroimaging protocols can provide converging evidence for neuroplastic brain remodelling during spontaneous and treatment-induced recovery. Researchers are also beginning to use sophisticated imaging analyses to improve accuracy of prognosis, which may eventually improve patient care by allowing for more efficient treatment planning. Brain stimulation techniques offer a new and exciting way to improve the recovery potential after stroke.     

The contribution of the left and right hemispheres to early recovery from aphasia: a SPECT prospective study

This prospective study examined the relationship between post-stroke recovery of aphasia and changes in cerebral blood flow (CBF). To address the question of right hemisphere (RH) involvement in restitution of language, we tested the hypothesis that the increase in perfusion of the RH is crucial for early recovery from aphasia. Twenty-four right-handed patients with acute aphasia following left hemisphere (LH) ischaemic stroke were examined twice with a six-month interval. At each session CBF and language scores were measured on the same stroke patients. Language was measured by selected tasks derived from the Boston Diagnostic Aphasia Examination (BDAE). The SPECT scans were obtained using (99m)Tc-ECD on a triple-head gamma camera Multispect-3. Although initial CBF measured for the whole group of aphasic patients was not a predictor for future language recovery for either hemisphere, increased perfusion of the RH during a six-month interval was found to parallel the recovery of aphasic disorders. There was a correlation between the change in the right parietal CBF (but not the left) and a change in numerous language abilities. Nevertheless, only CBF values on the left predicted performance on the language tests at initial and follow-up examinations. When the area damaged on structural imaging was excluded from perfusion analysis, only subcortical CBF change on the left showed a positive correlation with language improvement. Thus, the cerebral mechanism associated with early recovery from aphasia is a dynamic and complex process that may involve both hemispheres. Probably this mechanism involves functional reorganisation in the speech-dominant (damaged) hemisphere and regression of haemodynamic disturbances in the non-dominant (structurally intact) hemisphere.     

The contribution of the left and right hemispheres to early recovery from aphasia: A SPECT prospective study

This prospective study examined the relationship between post-stroke recovery of aphasia and changes in cerebral blood flow (CBF). To address the question of right hemisphere (RH) involvement in restitution of language, we tested the hypothesis that the increase in perfusion of the RH is crucial for early recovery from aphasia. Twenty-four right-handed patients with acute aphasia following left hemisphere (LH) ischaemic stroke were examined twice with a six-month interval. At each session CBF and language scores were measured on the same stroke patients. Language was measured by selected tasks derived from the Boston Diagnostic Aphasia Examination (BDAE). The SPECT scans were obtained using ^99mTc-ECD on a triple-head gamma camera Multispect-3. Although initial CBF measured for the whole group of aphasic patients was not a predictor for future language recovery for either hemisphere, increased perfusion of the RH during a six-month interval was found to parallel the recovery of aphasic disorders. There was a correlation between the change in the right parietal CBF (but not the left) and a change in numerous language abilities. Nevertheless, only CBF values on the left predicted performance on the language tests at initial and follow-up examinations. When the area damaged on structural imaging was excluded from perfusion analysis, only subcortical CBF change on the left showed a positive correlation with language improvement. Thus, the cerebral mechanism associated with early recovery from aphasia is a dynamic and complex process that may involve both hemispheres. Probably this mechanism involves functional reorganisation in the speech-dominant (damaged) hemisphere and regression of haemodynamic disturbances in the non-dominant (structurally intact) hemisphere.     

Research with transcranial magnetic stimulation in the treatment of aphasia

Repetitive transcranial magnetic stimulation (rTMS) has been used to improve language behavior, including naming, in stroke patients with chronic, nonfluent aphasia. Part 1 of this article reviews functional imaging studies related to language recovery in aphasia. Part 2 reviews the rationale for using rTMS to treat nonfluent aphasia (based on functional imaging) and presents our current rTMS protocol. We present language results from our rTMS studies as well as imaging results from overt naming functional MRI scans obtained before and after a series of rTMS treatments. Part 3 presents results from a pilot study in which rTMS treatments were followed immediately by constraint-induced language therapy. Part 4 reviews our diffusion tensor imaging study examining the possible connectivity of the arcuate fasciculus to different parts of Broca’s area (pars triangularis, pars opercularis) and to the ventral premotor cortex. The potential role of mirror neurons in the right pars opercularis and ventral premotor cortex in aphasia recovery is discussed.     

The neural basis of aphasia rehabilitation: evidence from neuroimaging and neurostimulation

This article is a selective review of functional imaging investigations and brain stimulation studies addressing the neural mechanisms of recovery of stroke-associated aphasia. The imaging results show that aphasia recovery is associated with a complex pattern of brain reorganisation, involving both ipsilateral and contralateral brain regions, which is modulated by lesion size and site, time post-onset, type of training, and language task. The information provided by the imaging investigations needs to be integrated with the results of brain stimulation studies, in order to specify the most effective protocols in term of modality, locus and timing of stimulation. Further studies, using multiple imaging and neuromodulation approaches, are required to reach sound conclusions about the potential usefulness of brain stimulation approaches as an adjunct to aphasia rehabilitation.     

The effect of music therapy on language recovery in patients with aphasia after stroke: a systematic review and meta-analysis

Neurological Sciences - The aim of this meta-analysis was to evaluate the evidence on the effectiveness of music therapy in the recovery of language function in post-stroke aphasia, compared with...     

多奈哌齐治疗卒中后失语疗效的Meta分析

目的 应用Meta分析方法评价多奈哌齐治疗卒中后失语的疗效.方法 检索多奈哌齐治疗卒中后失语症的随机对照研究文献,以失语商(AQ)为效应指标,对检索出的文献按固定效应模式通过Revman 4.2统计软件评价和分析多奈哌齐治疗卒中后失语的疗效.结果 12篇文献被纳入,仅3篇为高质量文献.与安慰剂组比较,治疗后多奈哌齐组在...