丘脑、基底节区卒中后认知损害研究

发布时间：2018-05-30 02:38

  本文选题：认知功能 + 卒中　； 参考：《浙江大学》2012年硕士论文

【摘要】：背景： 卒中后认知损害为当前研究热点,不同部位卒中引起的认知改变模式仍在不断探索和争议中。脑卒中后除了有躯体功能缺损,往往还伴有认知功能改变。以往认为皮层为主要大脑功能结构区,但是近年来发现皮层下结构也参与脑高级功能的形成。国内外对丘脑及基底节区卒中后各认知领域改变的研究仍较少。本课题拟从不同病灶部位认知损害比较的角度研究皮层下关键部位丘脑及基底节区卒中的神经心理特点,为早期识别血管性认知损害(VCI)患者提供依据,也为卒中后康复措施的制定提供依据。 目的： 本课题使用成套神经心理量表研究丘脑及基底节区卒中患者的认知改变特点,以推测皮层下结构与大脑高级功能的关系。本课题的意义在于认识非皮层结构损害后脑高级功能的改变模式,推测大脑深部结构的高级功能分化,从而在临床上为建构合理的VCI认知评估提供实证依据,同时,也便于早期识别VCI患者,并进行有效干预从而降低血管性痴呆(VaD)发病,减轻社会负担。 方法： 2009年12月至2011年11月之间,连续收集浙江省嵊州市人民医院神经内科门诊和住院的丘脑或基底节区单病灶卒中病人88例为病例组做横断面研究(左侧卒中41例,右侧卒中47例),其中男性64例,女性24例。分为以下四组：左侧丘脑卒中组(n=20)、右侧丘脑卒中组(n=21)、左侧基底节区卒中组(n=21)、右侧基底节区卒中组(n=26)；并入选健康老人34名为正常对照组,其中男性27名,女性7名。以上研究对象年龄均在50～80岁,教育年限、性别、年龄和抑郁自评量表差异无统计学意义。全部对象均完成成套认知功能检查,包括总体认知水平、记忆、语言、执行、注意和空间功能等各个认知领域。用SPSS11.5统计软件对各组认知指标进行分析。 结果： ①病例组与对照组比较：病例组在记忆功能、注意/执行功能、语言功能、空间功能等存在广泛的认知损害,明显差于对照组。②4组病例在相似性测验分析均有明显下降,其中左侧丘脑卒中组患者表现最差,左侧丘脑卒中组和右侧丘脑卒中组患者明显差于左侧基底节区卒中组和右侧基底节区卒中组患者,说明相似性测验得分与左右丘脑关系密切。③左侧丘脑卒中组和其他卒中组相比较：在言语功能、抑制干扰能力、信息处理速度和准确性、听觉词语延迟回忆、注意/执行功能、空间功能具有显著差异,与其他3个卒中组患者相比,左侧丘脑卒中组患者对认知功能影响最严重。④左侧基底节区卒中组和其他组比较：左侧基底节区卒中组患者的特点是与右手操作相关的项目(如TMT、SDMT)表现优于其他3个卒中组患者,而接近正常对照组。⑤右侧基底节区卒中组和其他组比较：SCWT-C正确数右侧基底节区卒中组患者表现最好,显著优于左侧丘脑、左侧基底节区卒中组患者,但与正常对照组比较,仍有明显下降。 结论： ①丘脑、基底节区卒中患者的认知损害较全面,包括记忆功能、执行功能、注意功能、语言功能和空间功能都受到显著影响,但损害模式各有不同,损害部位不同,认知损害表现不同。②左侧丘脑卒中患者的认知损害相对最为严重。
[Abstract]:Background :

The cognitive impairment after stroke is the focus of the current research , and the cognitive change pattern caused by stroke in different parts is still being explored and disputed . In addition to the body function defect after stroke , the cognitive function change is often accompanied by the change of cognitive function . In recent years , it has been found that the subcortical structure is also involved in the formation of brain advanced function .

Purpose :

This topic uses a set of neuropsychological scales to study the cognitive changes of stroke patients in the thalamus and basal ganglia , so as to predict the relationship between the subcortical structure and the advanced function of the brain . The purpose of this project is to recognize the change pattern of the advanced function of the brain in the non - cortical structure , and to estimate the high - level functional differentiation of the deep brain structure . At the same time , it is convenient for early identification of VCI patients and effective intervention to reduce the incidence of vascular dementia ( VaD ) and reduce the social burden .

Method :

From December 2009 to November 2011 , 88 cases of single - focus stroke patients in Shengzhou People ' s Hospital of Zhejiang Province were collected continuously , including 64 males and 24 females , including 64 males and 24 females , including 64 males and 24 females , including the following four groups : left anterior cerebral stroke group ( n = 20 ) , right group stroke group ( n = 21 ) , left basal ganglia stroke group ( n = 21 ) , right basal ganglia stroke group ( n = 26 ) ;
All the subjects completed a complete set of cognitive functions , including overall cognitive level , memory , language , execution , attention and spatial functions .

Results :

Compared with the control group , there were significant differences in cognitive function between the right basal ganglia stroke group and the right basal ganglia stroke group .

Conclusion :

The cognitive impairment of stroke patients in thalamus and basal ganglia was more comprehensive , including memory function , executive function , attention function , language function and spatial function were significantly affected , but the damage pattern was different , the lesion site was different , and the cognitive impairment was different . 鈶，

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