丘脑梗死与认知功能障碍的初步研究

发布时间：2018-05-24 04:36

本文选题：丘脑梗死 + 认知　；参考：《昆明医科大学》2012年硕士论文

【摘要】：目的对丘脑梗死后患者的各项认知指标进行初步研究,探讨丘脑梗死患者的记忆、视空间、执行功能、语言的不同受损程度进行量化评定以了解各种认知功能的变化特点以及相互之间的关系,从而进一步为探索丘脑在认知功能的形成过程中所起到的具体作用提供帮助,为今后临床具体诊断、积极康复以及预后估计提供量化参数和依据。方法以我院2011年3月至2012年3月神经内科收治的经临床与经磁共振诊断确诊为单侧和双侧丘脑梗死的患者40例为病例组,同时随机选取无任何神经系统疾病及其他躯体疾病的正常人共40例为对照组。所有入选患者在发病一周内病情稳定,能正常完成所有测验的情况下使用蒙特利尔认知评估量表(MOCA)、简明精神状态检查量表(MMSE)进行认知的总体评估；使用听觉词汇学习测试(AVLT)、数字记忆广度测试(DST)、临床记忆量表(CMS)评估记忆。使用符号-数字模式测验(SDMT)、线段等分测验(TLBT)、连线测试(TMT)、持续操作测验(CPT)评估患者视空间受损情况。使用威斯康星卡片分类测验(WCST)、词语流畅性测验(WFT)评估患者执行功能受损情况、使用汉语失语症检查量表(CAES)评估患者语言功能受损情况。同时结合病史及临床检查结果选取相应急性缺血性脑血管病危险因素——年龄、吸烟、饮酒、糖尿病、高血压、颈内动脉狭窄、高胆固醇血症、家族史共计7项作待分析指标,用以评价上述危险因素与认知指标变化的的相关性,评估完成后所得各项参数应用SPSS软件进行统计分析。结果病例组与对照组在所有测评指标上得分均有显著性差异,病例组得分显著低于对照组(P0.01,P0.05)；左侧丘脑梗死与双侧丘脑梗死组相比在在CC、RF,听名指物、听名指图、短句理解、图图搭配六项上得分有显著性差异(P0.01,P0.05)；右侧丘脑梗死组与双侧丘脑梗死组在AVLT、DST1、DST2、指向记忆(CMS)、联想学习(CMS)、图像自由回忆(CMS)、人像特点回忆(CMS)、总记忆商(CMS)、TMTA、CC、RC、RE、RCP、系列言语、执行命令、听写、自发书写、看图书写18项上得分有显著性差异(P0.01,P0.05)；右侧丘脑梗死组与左侧丘脑梗死组在MOCA、MMSE、AVLT、DST1、DST2、指向记忆(CMS)、联想学习(CMS)、图像自由回忆(CMS)、人像特点回忆(CMS)、总记忆商(CMS)、TMTA、CPT、RF、FM、在系列言语、听名指物、执行命令、听写、自发书写、看图书写20项上得分有显著性差异(P0.01,P0.05)。危险因素吸烟(X2)、糖尿病(X4)、高血压(X5)、梗死位置(X9)与丘脑梗死后认知功能下降关系密切。结论 1、丘脑参与了认知形成的全过程,丘脑梗死后各认知功能——记忆、视空间、执行功能、语言功能均有下降。 2、不同侧丘脑梗死后认知功能损害特点不同,左右两侧丘脑参与了认知形成的不同过程。 3、左侧丘脑损害后认知功能下降较右侧严重。左侧丘脑在记忆、视空间、执行功能、语言功能过程中可能比右侧丘脑发挥了更多的作用。 4、吸烟、糖尿病、高血压是丘脑梗死后认知功能的下降的相关危险因素。
[Abstract]:Objective To study the cognitive indexes of patients with cerebral infarction after cerebral infarction , to discuss the memory , visual space , executive function and different degree of impairment of the patients with cerebral infarction .

Methods 40 cases of patients with unilateral and bilateral cerebral infarction diagnosed as unilateral and bilateral acute cerebral infarction were diagnosed by clinical and magnetic resonance in our hospital from March 2011 to March 2012 , and 40 of them were randomly selected without any neurological diseases and other somatic diseases as control group . All selected patients were stable in the course of the disease and completed all tests normally , and the overall assessment of cognitive assessment was conducted using the Montreal Cognitive Assessment Scale ( MOCA ) and the Simple Mental State Examination Scale ( MMSE ) .
Using the Wisconsin Card Sorting Test ( WCST ) , the word fluency test ( WFT ) was used to assess the impairment of the patient ' s language function . The correlation between the risk factors and the change of cognitive indexes was assessed by using the Wisconsin Card Sorting Test ( WCST ) and the word fluency test ( WFT ) . The statistical analysis was carried out by SPSS software for the parameters obtained after the evaluation was completed .

Results The scores of the case group and the control group were significantly lower than those in the control group ( P0.01 , P0.05 ) .
Compared with the bilateral cerebral infarction group , the left hilus cerebral infarction had significant difference ( P0.01 , P0.05 ) .
There was significant difference ( P0.01 , P0.05 ) between right hilus cerebral infarction group and bilateral cerebral infarction group in AVLT , DST1 , DST2 , pointing memory ( CMS ) , associative learning ( CMS ) , image free memory ( CMS ) , portrait characteristic memory ( CMS ) , total memory quotient ( CMS ) , TMTA , CC , RC , RE , RCP , series speech , executive order , dictation and spontaneous writing .
There was significant difference ( P0.01 , P0.05 ) between the right group of cerebral infarction and the cerebral infarction group on the left side in MOCA , MMSE , AVLT , DST1 , DST2 , point - to - memory ( CMS ) , associative learning ( CMS ) , image free memory ( CMS ) , portrait characteristic memory ( CMS ) , total memory quotient ( CMS ) , TMTA , CPT , RF and FM . Risk factors smoking ( X2 ) , diabetes ( X4 ) , hypertension ( X5 ) , infarction location ( X9 ) were closely related to the decline of cognitive function after cerebral infarction .

Conclusion

1 . The thalamus participated in the whole process of cognition formation , and the cognitive function _ memory , visual space , executive function and language function decreased after cerebral infarction .

2 . Cognitive function impairment after cerebral infarction at different side was different , and the left and right thalamus were involved in different processes of cognition formation .

3 . The cognitive function of the left thalamus is lower than that on the right side . The left thalamus may play a more role in memory , visual space , executive function , and language function than in the right thalamus .

4 . Smoking , diabetes and hypertension are associated risk factors for the decrease of cognitive function after cerebral infarction .
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R743.3;R749.1

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