肝豆状核变性病患者记忆监测及道德判断的神经心理学研究

发布时间：2018-05-16 07:37

本文选题：肝豆状核变性病 + 记忆监测　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的记忆监测是个体对自身记忆状况的总体把握；道德判断指的是人们根据自己心目中的道德准则，按照所处特定文化或亚文化环境中规定的美好品德的标准，对个体行为进行好或坏的评价。记忆监测和道德判断的神经基础尚不十分明了，主要涉及的部位均位于前额叶。肝豆状核变性病患者皮层、基底节等区域广受累及，伴有多种认知能力受损，但尚无其记忆监测与道德判断的行为学研究。本文通过研究肝豆状核变性病（hepatolenticular degeneration，HLD）患者记忆监测及道德判断的情况，进一步了解HLD患者记忆监测障碍和道德感下降的损害特征，并探讨其可能的机制。方法选取在安徽中医药大学神经病学研究所附属医院神经科病房住院诊断为肝豆状核变性病的患者及30名人口学数据匹配的健康被试，进行知道感及道德两难情境决策的实验。采用SPSS17.0对数据进行统计学分析，采用两独立样本t检验及Pearson相关分析进行研究，以P＜0.05为差异有统计学意义。实验一：建立情景记忆(EM)及语义记忆(SM)的知道感(feeling-of-knowing，FOK)实验范式，对30例WD患者及30例年龄及教育程度相匹配的健康对照者（HC）进行研究。实验二：汉化使用Joshua D. Greene编写的道德两难问卷，问卷包括50个假设，，被试读题后作出“愿意这样做”或“不愿意这样做”的判断,对实验一中30例WD患者及30例年龄及教育程度相匹配的健康对照者（HC）进行研究。结果实验一：与HC组的FOK-EM的线索回忆率（64.17%±29.21%）以及FOK-SM的线索回忆率（84.72%±11.44%）比较，HLD患者组FOK-EM的线索回忆率（26.55%±20.92%）、FOK-SM的线索回忆率（53.93%±28.42%）显著降低，差异有统计学意义（t=-5.140,p0.01;t=-5.123,p0.01）；FOK-EM的肯定判断/正确再认成绩（50.64%±29.43%）、否定判断/正确再认成绩（12.80%±18.32%）与HC组的肯定判断/正确再认成绩（75.15%±31.73%）、否定判断/正确再认成绩（1.81%±5.41%）之间差异有统计学意义（t=-2.693,p0.05;t=3.026,p0.01）；且stroop效应与FOK-EM的否定判断/正确再认成绩呈正相关（r=0.601，p0.01）。实验二：HLD患者与健康对照在“个人情感的”道德判断中做出愿意（功利主义倾向）选择的概率显著的大于健康对照（t=3.908，p0.01），在“非个人情感的”道德判断和“道德无关的”判断中做出“愿意”回答的概率差异无统计学意义。结论HLD患者的情景记忆监测受损，表现为对自身再认能力的低估，这种记忆监测受损与执行功能的损害相关，推测前额叶功能损伤可能是导致HLD患者情景记忆障碍的重要因素；同时患者的语义记忆监测相对保留，提示语义记忆的知道感与情景记忆的知道感神经机制是不同的。患者在“个人情感的”道德判断中高度倾向于功利主义选择，推测与前额叶功能不足，道德决策过程中负性情绪加工障碍有关。前额叶与基底节之间直接和间接环路的损伤可能是HLD患者出现以上表现的神经基础。
[Abstract]:Objective memory monitoring is an individual's overall grasp of his or her own memory. Moral judgment refers to the standard of good character defined by people according to their own moral norms and according to their specific cultural or subcultural environment. A good or bad assessment of an individual's behavior. The neural basis of memory monitoring and moral judgment is not well understood, and the main sites involved are located in the prefrontal lobe. The cortical and basal ganglia were extensively involved in patients with hepatolenticular degeneration, accompanied by a variety of cognitive impairment, but there was no behavioral research on their memory monitoring and moral judgment. By studying the memory monitoring and moral judgment of patients with hepatolenticular degeneration-induced disease (HLD), we further understand the characteristics of impaired memory monitoring and moral decline in patients with HLD, and explore its possible mechanism. Methods 30 healthy subjects who were diagnosed as hepatolenticular degeneration in the neurology ward of the affiliated Hospital of Institute of Neurology of Anhui University of traditional Chinese Medicine and 30 healthy subjects with matched demographic data were selected to conduct the knowledge sense and moral dilemma decision making experiment. SPSS17.0 was used to analyze the data, two independent samples t test and Pearson correlation analysis were used to study the data. The difference was statistically significant (P < 0. 05). Experiment 1: to study 30 WD patients and 30 healthy controls matched with age and education by establishing the perception-of-knowing FOK paradigm of situational memory (EMM) and semantic memory (SMSM). Experiment 2: the Chinese version of the moral dilemmas questionnaire, written by Joshua D. Greene, consisted of 50 hypotheses. After reading the questions, the subjects made a judgment of "willing to do this" or "not willing to do so". In experiment 1, 30 WD patients and 30 healthy controls matched with age and education were studied. Results in experiment 1, compared with HC group (64.17% 卤29.21%) and FOK-SM group (84.72% 卤11.44%), the clue recall rate of FOK-EM group (26.55% 卤20.92% 卤28.42%) was significantly lower than that of HC group (53.93% 卤28.42%). The difference was statistically significant between the positive judgment / correct recognition of FOK-EM (50.64% 卤29.43%, negative judgment / correct recognition 12.80% 卤18.32%) and the positive judgment / correct recognition of 75.15% 卤31.737.30% in HC group and 1.81% 卤5.41% in negative judgment / correct recognition score. There was a positive correlation between the stroop effect and the negative judgment / correct recognition of FOK-EM. Experiment 2: HLD patients and healthy controls were significantly more likely to make a willing (utilitarian) choice in "personal emotional" moral judgment than the healthy control (t = 3.908 / p 0.01), and had no relationship with "non-personal emotional" moral judgment. There was no statistically significant difference in the probability of making a willing answer in the judgment. Conclusion the impairment of situational memory monitoring in patients with HLD is characterized by an underestimation of their recognition ability. The impairment of memory monitoring is related to the impairment of executive function. It is speculated that the impairment of prefrontal function may be an important factor leading to the impairment of situational memory in patients with HLD. At the same time, the patients' semantic memory monitoring is relatively reserved, suggesting that the sense of knowledge in semantic memory is different from that in situational memory. The patients were highly inclined to utilitarianism in the moral judgment of personal emotion, which was related to the deficiency of prefrontal function and the negative emotional processing disorder in the process of moral decision. The injury of direct and indirect loop between the prefrontal lobe and basal ganglia may be the neural basis of the above findings in HLD patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.4

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