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。     

性别、年龄、卒中类型与卒中后失语症类型的相关性分析

【摘要】
目的 本文旨在探讨性别、年龄、卒中类型和卒中后失语症分类间的关系。
方法 回顾性分析2005年7月～2012年7月首都医科大学附属北京天坛医院收治的符合病例入排标准的421例急性卒中患者,应用北京大学第一医院神经内科汉语失语检查法中的利手评定标准进行利手判定、西部失语成套测验进行失语症的分类及失语指数（Aphasia Quotient,AQ）评分,按照年龄不同分为青、中、老年三组,按卒中类型分为脑梗死及脑出血,结合不同性别观察失语症类型的分布情况,比较不同年龄、性别以及卒中类型间失语症类型分布有无差异。
结果 入选患者均为右利手,男性占69.60%,女性占30.40%。失语症类型如下：运动性失语116例（男85例,女31例）,感觉性失语35例（男20例,女15例）,传导性失语15例（男10例,女5例）,经皮质运动性失语63例（男50例,女13例）,经皮质感觉性失语11例（男8例,女3例）,经皮质混合性失语27例（男13例,女14例）,命名性失语73例（男47例,女26例）,完全性失语81例（男60例,女21例）,经统计学分析,男性卒中后失语症发生率（69.60%）明显高于女性（30.40%）（χ2=11.57,P=0.003）,尤以青中年（≤65岁）为主（73.38%）,老年期（>65岁）女性发生率逐渐升高（42.97%）,与男性差异逐渐缩小（26.28%）;性别对失语症类型无明显影响（χ2=13.84,P=0.054）,男女患者均以运动性失语最常见（分别为29.01%、24.22%）;各年龄组患者失语类型分布无明显差异（χ2=14.94,P=0.382）。脑梗死所致失语症患者较脑出血所致者更为多见（分别为306例和115例）,但在失语症类型分布上差异无显著性（χ2=13.23,P=0.067）,除女性脑出血患者外,均以运动性失语最为常见（分别为29.82%,29.55%,26.67%）。
结论 年龄、性别及卒中类型对卒中后失语症类型分布均无明显影响,男性卒中后失语发生率明显高于女性且患病平均年龄小于女性,两性中均以运动性失语最常见;除去女性脑出血患者外,均以运动性、完全性及命名性失语最常见。     

卒中类型、卒中部位与卒中后癫痫的多因素关系

目的探讨卒中类型、卒中部位与卒中后癫痫的多因素关系,为卒中后癫痫的防治提供参考。方法以1804例卒中患者为研究对象,收集其性别、年龄、卒中类型、卒中部位、卒中后癫痫发生的时间等资料,根据卒中后是否发生癫痫,将患者分为卒中后无癫痫组(n=1487)和卒中后癫痫组(n=317),分析卒中后癫痫发作的危险因素。结果共317例卒中后癫痫发作患者,其中早发性癫痫141例(44.48%),迟发性癫痫176例(55.52%)。不同卒中部位及卒中类型的癫痫发病率为17.57%。多因素logistic回归分析显示,卒中部位中的顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶是卒中后发生癫痫的危险因素(P<0.01),其中单一颞叶是卒中后早发性癫痫的危险因素(P<0.01)。脑梗死患者常见早发性癫痫(23.66%),脑出血患者常见迟发性癫痫(47.95%)。结论卒中类型中的脑梗死、脑出血、蛛网膜下腔出血与卒中后癫痫有关;卒中部位中顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶与卒中后癫痫有关。     

卒中后失语症听理解障碍相关神经通路的研究进展

<正>脑卒中在世界范围内60岁及以上人群中居死因第2位,15～59岁人群中居死因第5位^[1]。卒中患者常遗留运动、感觉、认知等不同方面的神经功能损害,影响其日常生活和工作,给家庭及社会带来巨大的负担。而失语症作为脑卒中主要的后遗症之一,存在于21%～38%的卒中患者中^[2]。卒中后失语会极大的影响患者的交流和生活质量,并且对卒中急性期和慢性期的康复造成不利影响^[3]。本文通过对既往失语症中听理解相关神经通路的研究进行回顾与梳理,     

维吾尔语失语症与脑卒中病变部位关系的临床研究

目的 分析脑卒中后维吾尔语失语症类型与病变部位的关系.方法 选择符合入选标准的脑卒中后维吾尔语失语症患者52例,应用改良的失语检查法进行失语症的评定,并在入院后1w内完成头部CT或MRI检查.结果 52例患者中,运动性失语24例,完全性失语12例,命名性失语4例,基底节性失语4例,经皮质运动性失语4例,感觉性失语2例,混合性失语1例,经皮质感觉性失语1例.病变部位位于经典语言中枢的30例,占57.69％.结论 脑卒中后维吾尔语失语症类型与病变部位有一定关系,部分与经典的语言中枢一致.     

老年人卒中后癫癎的临床特点

脑卒中继发癫癎是脑血管病的常见并发症。我院自1999～2003年收治的经CT／MIU证实的脑卒中住院患者1344例，其中144例(10．7％)继发癫癎，男性84例，女性60例。现对临床资料进行分析，以探讨其临床特点和发病机制。     

卒中后抑郁

卒中后抑郁 (PSD)早在 2 0世纪 40年代国外就有学者报道过 ,但当时仅将它归咎于卒中后躯体功能障碍产生的心理反应。近 10多年的研究证明 PSD与卒中有着直接关系 ,抗抑郁治疗不但能提高卒中患者的生活质量 ,而且有助于卒中后神经功能的康复。1　患病率PSD的患病率在 30 %左右 [1 ,2 ] ,Eastwood等 [3 ] 调查一组卒中患者的 PSD患病率高达 5 0 % ,国内张庆臣等 [4]报告PSD患病率为 5 5 %。有文献报告老年期静止性脑梗死 (SCI)病人中 PSD的发生率则更高 ,老年期 SCI发生率约 30 %左右 ,而老年期严重抑郁或躁狂病人 SCI的发生率可…     

卒中后癫痫发作与卒中后癫痫

卒中是引起癫痫的常见原因,本文就卒中后癫痫发作和卒中后癫痫的定义、发病机制、卒中后癫痫发作类型、癫痫发作的影响因素及治疗进展等做一综述。     

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.     

卒中后睡眠障碍

睡眠障碍是卒中后常见的并发症之一,会影响卒中患者的预后及生活质量。卒中后睡眠障碍的原因不完全清楚,主要与梗死部位、神经递质、社会心理因素等有关。它主要分为呼吸相关性睡眠障碍和非呼吸相关性睡眠障碍两类,其中呼吸相关性睡眠障碍是较常见的类型。在卒中后睡眠障碍的治疗方面,药物治疗和非药物治疗相辅相成。临床医师应增强意识,尽早识别卒中后睡眠障碍类型,予以干预,以期改善患者预后,提高患者生活质量。     

言语训练结合头皮针灸治疗卒中失语症患者的疗效分析

目的 探讨分析言语训练结合头皮针灸在卒中失语症患者中改善言语功能、认知功能和日常生活 活动能力的临床疗效。      

卒中后失语患者非语言认知功能损害特点的临床研究

目的 探讨卒中后失语患者非语言认知功能损害的特点，并分析卒中后失语患者语言障碍与非语言 性认知功能损害之间的关系。 方法 选择2017年5月-2018年6月就诊的卒中患者共32例，经西方失语症成套测验（western aphasia battery，WAB）评估语言功能，分为失语组和无失语组，其中失语组15例，无失语组17例。洛文斯顿成 套测验中文版（Loewenstein occupational therapy cognitive assessment，LOTCA）第2版评估患者非语言认 知功能。对失语组与非失语组的LOTCA各分项分值及总分分别进行非参数检验；对WAB中各分项得 分及失语商与LOTCA各认知分项得分及总分进行偏相关分析，并行多元逐步回归分析。 结果 失语组的LOTCA总分低于无失语组，差异有统计学意义[85.0（69.0～92.0）分 vs 99.0 （86.0～102.5）分，P <0.05]；失语患者LOTCA总分与WAB各分项及失语商呈正相关（r =0.587～0.883， 均P <0.05），WAB分项中的各分项与LOTCA中各分项之间呈正相关（r =0.521～0.843，均P <0.05）；多 元逐步回归分析显示，影响患者失语商的主要因素为LOTCA总分（β=0.707，P =0.003）。 结论 卒中后失语患者存在非语言认知功能障碍，失语程度越重其非语言认知功能受损程度越重。     

Age and aphasia: a review of presence,type, recovery and clinical outcomes

Background: Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less clear.

Objectives: To complete a review of the literature to examine the relationship between age and: (a) presence or likelihood of aphasia after stroke, (b) aphasia type, (c) aphasia recovery patterns, and (d) aphasia clinical outcomes.

Data Sources: Articles were identified by a comprehensive search of “OneSearch,” PubMed, and individual journals: Aphasiology, Stroke and the Journal of Stroke and Cerebrovascular Diseases.

Study Selection: Inclusion criteria included: age and incidence of aphasia, likelihood of aphasia, aphasia recovery, and aphasia clinical outcome.

Data Extraction: Independent searches were completed by the authors. Each author independently assessed the full text of reports meeting inclusion criteria. Differences regarding study eligibility and need to proceed with data extraction were resolved by consensus.

Results: 1617 articles were identified during the initial search. Forty studies including 14,795 study participants were included in the review. The review generally demonstrated that: (a) stroke patients with aphasia are typically older than stroke with patients without aphasia and (b) aphasia type and age are associated as younger patients with aphasia are more likely to exhibit non-fluent or Broca’s type of aphasia. In contrast, studies examining aphasia recovery and aphasia clinical outcomes did not demonstrate a positive relationship between age and recovery or clinical outcomes.

Conclusions: Stroke is a condition of the elderly. However, age appears to only influence likelihood of aphasia and aphasia type.     

A Retrospective Study to Identify Novel Factors Associated with Post-stroke Anxiety

Background and Purpose: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. Methods: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. Results: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. Conclusions: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.     

The problems faced by informal carers to people with aphasia after stroke: A literature review

Background: In addition to other stroke related impairments, up to 12% of those who survive stroke have ongoing problems with aphasia. Research suggests that informal carers to those with aphasia after stroke experience a greater overall burden of care than those who care for stroke survivors without aphasia. One of the keys to understanding this is a clear appreciation of the problems faced by carers of stroke survivors with aphasia.

Aims: Via review of the literature to identify the problems faced by informal carers to those having aphasia after stroke.

Methods & procedures: Studies listed in AMED, CINAHL, EMBASE, MEDLINE, and PsycINFO databases were searched for articles published up until 10^th June 2012, using specified search terms. Reference lists of papers obtained were hand-searched. The studies were rated according to the appropriateness of the study design and the quality with which the research was executed. The results of studies of higher quality were given greater weighting.

Outcomes & Results: Fourteen studies were found that complied with the study criteria. The majority of research was cross-sectional. There was a balance of qualitative and quantitative studies. There were methodological problems with all of the studies. Seven studies were rated as low quality and the remainder were rated as moderate quality. It was established that there is reasonable evidence to suggest that informal carers to people with aphasia after stroke commonly experience problems in the following areas: role changes/new responsibilities, difficulties with social and leisure activities, communication difficulties with the stroke survivor, employment and financial problems, problems in dealing with health professionals, relationship difficulties with the stroke survivor, difficulties in family relationships, lack of support or respite, managing difficult behaviours in the stroke survivor, physical health problems/fatigue, and emotional health problems.

Conclusions: This paper provides an update and improvement upon a previous review of the literature in this subject area. There is a lack of longitudinal research and therefore little is known about how the problems experienced by informal carers of stroke survivors with aphasia change over time. Carer gender and carers’ perception of the self-care deficits of the stroke survivor emerge as potentially significant covariables requiring further investigation. Clinical implications of the findings and limitations are discussed.     

Exploring the use of graphics in written health information for people with aphasia

Background: One of the documented design features of aphasia-friendly written information is the inclusion of graphics. People with aphasia have identified a preference for the inclusion of photographic illustrations in printed education materials (PEMs); however this preference contrasts with research suggesting that line drawings may be a more effective graphic type. Few studies have explored how graphics affect reading comprehension for people with aphasia.

Aims: The aims of this research were (1) to determine if black and white line drawings and colour photographs affect the reading comprehension of people with and without aphasia, and (2) to explore perceptions of graphic helpfulness and preferences for including line drawings and photographic illustrations in PEMs.

Methods & Procedures: A total of 22 people with aphasia and 15 of their significant others completed a purposefully developed cloze reading comprehension task, with multiple-choice response options. Response options contained (1) no illustrations, (2) black and white line drawings, or (3) colour photographs. The reading comprehension task was timed. The impact of no illustrations, line drawings, and photographs on (a) reading comprehension (measured in number of paragraphs correctly completed), and (b) response times (measured in seconds) was examined. Participants also completed a face-to-face graphic preference survey.

Outcomes & Results: There were no significant differences on the reading comprehension task for participants with aphasia and those without, between (a) the number of paragraphs correctly completed in the set with no graphics, line drawings, and photographs, (b) the time taken to complete paragraphs in each of the three sets, and (c) the mean time taken to correctly complete paragraphs in each of the three sets. In contrast, the majority of participants perceived that pictures help understanding and make reading quicker. Significantly more participants with aphasia, compared to participants without, reported that they needed pictures to understand writing, and all participants with aphasia preferred health information to contain graphics. Several participants did not have a preference for line drawings or photographs in PEMs. Of those who did have a preference, more participants preferred written health information to contain photographs.

Conclusions: Both participants with and without aphasia perceived that graphics in PEMs were helpful, however significantly more participants with aphasia reported that graphics were needed to understand text. The finding that line drawings and colour photographs did not significantly assist comprehension should not discount other benefits graphics may have in PEMs for people with aphasia.     

Bedside screening for aphasia: a comparison of two methods

A prospective study was carried out in 50 consecutive patients referred with suspected aphasia in order to compare the Frenchay Aphasia Screening Test (FAST) with the Sheffield Screening Test for Acquired Language Disorders (SST). The study included 32 men and 18 women with a mean (SEM) age 53.9 (2) years. The comprehension scores on the FAST were correlated with receptive skills on the SSTr=0.74 (P<0.001). For expression, the correlation coefficient wasr=0.92 (P<0.001) and the total scores of the two tests correlated closelyr=0.89 (P<0.001). There was a positive correlation between total score on the FAST and the Short Orientation, Memory and Concentration test (SOMC)r=0.86 (P<0.001), and the total scores on the SST and SOMCr=0.91 (P<0.001). The Barthel index also correlated positively with the FASTr=0.59 (P<0.001) and SSTr=0.63 (P<0.001). The study demonstrated that the two tests are simple, short and similar in their predictive value for the screening and diagnosis of aphasia. The SST was found to have additional advantages, as it does not require any special equipment or stimulus cards, and it was not affected by visual neglect.     

Factors Associated with Changes in Community Ability and Recovery After Psychiatric Rehabilitation: A Retrospective Study

One of the key goals of psychiatric rehabilitation is to return individuals with mental illnesses back into the community via restoration of the necessary skills. This retrospective study seeks to evaluate the factors associated with improvement in community functioning after a period of outpatient rehabilitation. 223 individuals enrolled into three broad rehabilitation groups—clinical, vocational and creative therapies/individual sessions—were included in this study. The Multnomah Community Ability Scale (MCAS) and Milestones of Recovery Scale (MORS) were used to evaluate each individual before and after the rehabilitation programme. Across all three groups, there were significant improvements in MCAS scores and MORS ratings. In multivariate models, clinical rehabilitation group was superior to creative therapies/individual sessions in predicting MORS change. The study also revealed a close relationship between recovery gains and improvement in community ability.