缺血性脑卒中继发血管性痴呆患者与头颅CT所示病变部位的相关性研究

目的 探讨缺血性脑卒中患者继发血管性痴呆(VaD)与头颅CT所示病变部位的相关性。方法 纳入2014年5月1日～2015年5月1日收治的缺血性脑卒中患者为研究对象。收集患者入院后的CT检查表现,采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、Addenbrooke改良认知评估量表(ACE-R)评估患者脑卒中后3个月的认知功能; 以患者是否继发VaD为因变量,脑组织病变部位为自变量,采用单因素和多因素logistic回归分析研究不同病变部位对于缺血性脑卒中患者继发认知功能障碍的相关性。结果 经随访,最终纳入66例缺血性脑卒中患者,其中36例继发VaD,30例认知功能正常,2组基线资料无显著差异性(P>0.05)。单因素logistic回归分析显示,下丘脑、丘脑后部、左额/颞/枕以及多发病灶、脑白质病变、脑萎缩对缺血性脑卒中患者继发认知功能障碍产生影响(P<0.05); 多因素logistic回归分析显示,5项自变量进入回归模型,包括下丘脑、左额、左枕、多发病灶、脑白质病变(P<0.05)。结论 下丘脑、左额、枕以及多发病灶和脑白质病变是缺血性脑卒中患者继发VaD的危险因素,临床上应及时予以干预。     

脑卒中失语症的早期康复治疗

目的观察康复训练对脑卒中失语症的疗效。方法对38例脑卒中失语症患者给予Schuell刺激法进行语言训练。结果脑卒中失语症患者语言训练效果良好。结论语言训练对脑卒中失语症的康复有积极作用。     

脑卒中后运动性失语症的研究进展

正运动性失语又称Broca失语(Broca’s aphasia,BA)是脑卒中后常见的失语症类型之一,是由Paul Broca于1865年首次提出且被广泛公认的一种失语症类型。临床特征以听理解能力相对良好、口语表达障碍为突出特点,一直以来为国内外学者热衷研究的课题。1运动性失语症的发病机制目前,运动性失语症的发病机制尚不完全清楚,多数学者认为可能为病变本身直接破坏Broca区或由于远隔效应     

电针刺激配合语言训练治疗脑卒中失语症的临床研究

目的　探讨电针刺激配合语言康复训练对脑卒中语言功能恢复的影响。方法　选取急性脑卒中失语症患者 90例 ,分成A组与B组。A组在常规治疗的基础上给予头针、体针电刺激配合语言训练 ;B组常规治疗配合语言功能训练。治疗 3周后统计分析两组患者语言功能的改善程度。结果　A组显效率 68 9% ,有效率 2 4 4% ,无效率 6 7% ;B组显效率 3 7 8% ,有效率3 5 5 % ,无效率 2 6 7% ,两组比较有显著性差异 (P <0 0 5 ) ,有统计学意义。结论　电针刺激配合语言训练可促进脑卒中失语症患者的语言功能恢复 ,且明显优于单纯语言功能训练。     

脑卒中后失语症的早期康复临床研究

目的 探讨脑卒中后失语症的早期康复训练效果。方法 采用不同方法对36例脑卒中(脑出血、脑梗死)进行康复训练。结果 命名性失语效果最好,运动性失语次之,完全性失语效果差。并对脑出血、脑梗死组对照分析,经X2检验,P<0.05,说明脑出血比脑梗死治疗效果好。与不同治疗组的疗效比较,P<0.01。同时治疗组进行了年龄与文化程度比较,提示年龄、文化程度高者恢复快。结论 失语患者在接受语言康复训练应个体化,早期进行,坚持不懈,重视出院后的家庭康复训练,应列为脑卒中后失语症治疗的基本内容。     

脑卒中失语症的早期个体化语言康复训练

目的 探讨早期个体化语言康复训练的效果.方法 将60例脑卒中失语症患者随机分为早期康复组、延迟康复组和对照组,针对患者失语症类型合理组合语言训练手段进行1个月的治疗,用西方失语症成套测查量表(WAB)在治疗前后进行失语商(AQ)测查,并在3组之间进行比较.结果 治疗前3组间AQ评分差异无显著性(P＞0.05),治疗后早期康复组、延迟康复组与对照组比较均有显著性差异(P＜0.05),早期康复组与延迟康复组之间亦有显著性差异(P＜0.05).结论 早期语言康复训练较延迟语言康复训练有更好的疗效.针对患者失语症类型合理组合语言训练手段的语言康复有更好的疗效.     

脑卒中伴失语症言语治疗效果观察

我们对2007—2009年本院收治的不同类型的脑卒中伴失语症患者进行语言治疗,现报道如下。     

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。     

Etiology of stroke in patients with Wernicke's aphasia

We reviewed 49 patients with Wernicke's aphasia resulting from a stroke. Their aphasia was classified on the basis of comprehensive neuropsychological testing. Wernicke's aphasia was more common in older patients and in men. Cerebral infarction occurred in 38 patients (78%) and intracerebral hemorrhage in seven (14%); the remaining four patients (8%) developed aphasia after surgery for aneurysmal subarachnoid hemorrhage. Embolic events were the most common etiology of Wernicke's aphasia in the 38 patients with cerebral infarction, with cardiac emboli in 40% and large-vessel atheroemboli from a carotid source in 16%. In patients with Wernicke's aphasia secondary to infarction, an embolic source should be sought. Patients with Wernicke's aphasia should have computed tomography to exclude intracerebral hemorrhage before institution of anticoagulant therapy.     

Age and type of aphasia in patients with stroke.

The age and gender of a series of patients with different types of aphasia were analysed. Regardless of gender, patients with Broca and conduction aphasias were significantly younger than those with Wernicke and global aphasias. Considering the established cerebral localisation of each of those aphasia types, it appears that, with age, stroke in the territory of the middle cerebral artery will tend to either shift posteriorly (producing Wernicke aphasia) or occupy most of the middle cerebral artery territory (producing global aphasia). But in the absence of concurrent verification of the locus of lesion in each of the cases in our sample, a possible alternative hypothesis must be entertained: that there might be age-related changes in the neurophysiological mechanism subserving language, such that some types of aphasia would tend to be more prevalent with age, regardless of lesion location.     

Catamnestic studies of patients with aphasia after stroke

In 28 patients with aphasia after stroke speech ability was studied twice at intervals of 1-4 years. A comparison of the initial results with those after follow-up showed that the process of return of speech ability (especially in case of motor aphasia) is not limited to the early post-stroke period of several weeks to several months, but takes a much longer time. This justifies logopedic treatment of aphatic patients (also in sanatorium) even many months after stroke.     

不同型失语症患者的复述障碍

目的 探讨不同型失语症患者的复述障碍特点。方法 设计8组近音单字词及词的图画,对不同型失语症患者做复述检查。结果 3例传导性失语症患者复述障碍最重,复述错误主要为音位性错语,但大多配画正确;3例经皮质感觉性失语症患者的复述错误中,9个音位性错语及2个词义性错语,大多错语配画正确,但16个复述正确的词配错画;7例经皮质运动性失语症患者中,5例复述和配画全对,另1例口语表达表现为语音障碍,1例在复述中有持续现象。结论 本文三型失语症患者复述障碍的特点不同,揭示其复述障碍各有不同的病理生理机制。     

Severity of aphasia and recovery after treatment in patients with stroke

Background: Aphasia due to stroke is often very severe immediately after onset. However, knowledge about the impact of severity on therapeutic potential in the first months is scarce. The optimal therapeutic approach for patients with severe aphasia is still subject to debate.

Aims: To explore the recovery pattern of verbal communication in stroke patients with aphasia of varying degrees of severity receiving language therapy during the first 6 months poststroke.

Methods & Procedures: We used data from our previous trial in which 80 patients with aphasia due to stroke were randomised within the first 3 weeks postonset for either cognitive-linguistic therapy (CLT) or communicative therapy. All patients were tested at baseline and at 3 and 6 months postaphasia onset. We formed three severity groups, based on baseline Amsterdam–Nijmegen Everyday Language Test scores. We used repeated measures ANOVA to compare test scores at baseline and at 3 and 6 months poststroke onset for each of the three severity groups, stratified for the two treatments.

Outcomes & Results: Patients with severe or very severe aphasia improved substantially during follow-up, especially during the first 3 months poststroke. Improvement was less pronounced in the moderate to mild group. Although improvement did not differ significantly between the two treatment arms of the trial during the first 6 months poststroke, the very severe group seemed to benefit particularly from CLT (mean difference between treatments was 4.1 points; 95% CI: ?4.0 to 12.2).

Conclusions: Even in very severely aphasic patients, considerable improvement of functional communication is possible. These patients might benefit more from early initiated CLT therapy than generally assumed. Hence, speech and language therapists should not refrain from applying CLT in the acute phase of rehabilitation of severe aphasia.     

Spontaneous recovery of language in patients with aphasia between 4 and 34 weeks after stroke.

The paper describes the spontaneous recovery of language abilities of 52 stroke patients who were aphasic for more than 4 weeks. These patients had been randomly allocated to receive no speech therapy and had been assessed at 6-weekly intervals after a stroke. There was improvement in language abilities over time. Age, sex and aphasia type were not related to the amount of improvement. An aphasic patient's level of language ability at 6 months could be predicted on the basis of the test score on the Porch Index of Communicative Ability at 4 weeks.     

Executive control deficits and lesion correlates in acute left hemisphere stroke survivors with and without aphasia

Brain Imaging and Behavior - In contrast to the traditional definition of the disorder, many individuals with aphasia exhibit non-linguistic cognitive impairments, including executive control...     

伴运动性失语脑卒中患者抑郁的临床研究

目的 探讨伴运动性失语脑卒中患者的抑郁状况.方法 采用失语抑郁量表(ADRS)及Zung抑郁自评量表(SDS) 对首次卒中伴运动性失语(失语组,66例)患者进行测评,并与无失语卒中患者(对照组,66例)进行比较.结果 失语组抑郁发生率(62.12%)明显高于对照组(25.76%)(P<0.01);失语组中、重度抑郁发生率(41.46%、12.20%)明显高于对照组(29.41%、0;P<0.05～ 0.01);且抑郁发生率随失语程度加重而显著增高(均P<0.01).结论 卒中伴运动性失语患者抑郁的发生率明显增高,且抑郁的发生率与失语严重程度相关.     

Task-modulated neural activation patterns in chronic stroke patients with aphasia

Background: Neuroimaging research on language recovery in patients with aphasia due to left hemisphere damage has generated some intriguing results. However, it is still not clear what role the right hemisphere plays in supporting recovered language functions in the chronic phase for patients with different site and size of lesion when different tasks are used.

Aims: The present study aimed at exploring the role of perilesional, ipsilesional, and contralesional activation in participants with aphasia with different site and size of lesion using two different language tasks. All participants were in the chronic stage with well- recovered or significant improvements in language functions.

Methods & Procedures: Functional magnetic resonance imaging (fMRI) was used to characterise brain activations in eight stroke patients and eight age/gender-matched controls during semantic judgement and oral picture naming. An event-related design using jittered interstimulus intervals (ISIs) was employed to present the stimuli.

Outcomes & Results: The fMRI scans of both language tasks in patients revealed differences in activation pattern relative to the normal control participants. The nature of this difference was task specific. During the semantic judgement task patients without lesions involving the left frontal region activated the left inferior frontal gyrus similar to observations in the normal control participants. Participants with left frontal lesions activated contralesional regions in addition to perilesional left frontal regions. During the picture-naming task all participants activated bilateral brain regions irrespective of the site or size of lesion, consistent with other published studies utilising this task. Subsequent regions of interest analysis and laterality index analysis revealed that patients with large lesions produced greater right hemisphere activation than patients with small lesions.

Conclusions: The results of this study demonstrate that recovery is task, lesion site, and size specific. Further, the results also indicate a role for both activation of homologous contralesional cortex and activity of left hemisphere regions (perilesional and ipsilesional) as efficient mechanisms for supporting language functions in chronic stroke patients.     

Aphasia assessment and functional outcome prediction in patients with aphasia after stroke

Available studies did not clarify whether a language examination may predict functional and motor outcome in patients with aphasia undergoing rehabilitation. This was the aim of the current study. Language examination considered in this study was the Aachen Aphasia Test (AAT). One hundred fifty-six patients with a primary diagnosis of acute cerebrovascular accident of left hemisphere were included: 105 with and 51 without aphasia. Backward stepwise regression analysis was used to predict final scores in total-, motor-, and cognitive-Functional Independence Measure (FIM). The independent variables were age, gender, stroke type, stroke lesion size, onset to admission interval, National Institute of Health Stroke Scale, Fugl-Meyer Scale, Trunk Control Test, initial motor-FIM, and AAT (spontaneous speech, token test, repetition, written language, confrontation naming, comprehension). In the multivariate regression analysis, comprehension was the only function of the language to be predictor of the final total-FIM (β = +0.35) and final cognitive-FIM (β = +0.61). Comprehension was a predictor of total-FIM (β = +0.27) and cognitive-FIM (β = +0.54) as well, when additional backward stepwise regression analysis (which did not include comprehension and expression scores in the final total- and cognitive-FIM) was performed. When multivariate regression analysis took into consideration only language functions as independent variables, spontaneous speech (β = +0.41) only was the predictor of motor-FIM. The study highlights that AAT is the predictor of functional outcome in the patient with aphasia. Among the functions of language, comprehension seems to be the most important predictive factor of total- and cognitive-FIM, while spontaneous speech seems to be a predictor of motor-FIM.