面肌痉挛患者风险决策能力的神经心理学研究

发布时间：2018-08-25 11:17

【摘要】：目的面肌痉挛是一种神经血管压迫引起的慢性运动功能紊乱性疾病,长期间断的、不自主的面部肌肉收缩必然会造成患者一定程度上的生理和心理压力,伴有不同程度的焦虑、抑郁等情绪问题,长期的压力下甚至可能对患者的认知、社会行为产生一定的影响,研究发现面肌痉挛患者明确存在焦虑、抑郁等情绪问题及认知功能障碍。决策是社会认知的重要组成部分,也是一种重要的日常生活功能,决策能力的受损会对患者的社会功能产生很多不必要的麻烦。目前为止,尚无面肌痉挛患者决策能力的相关研究。本研究采用爱荷华博弈实验(Iowa Gambling Task,IGT)探讨面肌痉挛患者在风险模糊情境下的决策功能和骰子博弈测试(Game of Dice Task,GDT)探讨面肌痉挛患者在风险明确情境下的决策功能是否改变,并探讨面肌痉挛患者认知行为能力受损可能的神经机制。方法招募44例在肉毒素治疗门诊的面肌痉挛患者和39例在年龄、教育程度、性别构成与之相匹配的健康对照组进行IGT和GDT。主要的统计指标是IGT任务的净得分,即有利选项数目-不利选项数目,IGT任务的总盈利;GDT任务的净得分,即非风险选项数目-风险选项数目,GDT任务的总盈利;GDT任务的正负反馈利用率。同时完成相关的神经心理学测试的评估:简明精神状态量表(Mini-Mental State Examination,MMSE)、Stroop色字实验(Stroop Colour and Word Test,SCWT)、数字广度测试(Digit Span Test,DS)和词汇流畅性测试(Verbal Fluency Test,VFT)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA),统计IGT或GDT任务的净得分与面肌痉挛患者相关的神经心理学特征是否相关。结果面肌痉挛组和健康对照组在GDT上的净得分(-4.32±7.906)vs.(3.85±8.502),差异具有统计学意义(t=-4.532,P=0.000);两组被试的负反馈利用率(面肌痉挛组:32.43±26.58;健康对照组:57.19±32.16)存在统计学意义(t=-3.666,P=0.000)。而两组被试(面肌痉挛组:-0.14±18.454;健康对照组:5.28±17.275)在IGT的净得分无统计学差异(t=-1.376,P=0.173);两组被试在MMSE,SCWT,数字广度测试(顺背)(digit span test(forward),DSf)和VFT上的得分差异无统计学意义(P0.05),而在数字广度测试(倒背)(digit span test(backward),DSb)(t=-3.293,P=0.001),HAMD(t=8.367,P=0.000)和HAMA(t=7.611,P=0.000)上的得分存在统计学的差异。面肌痉挛患者的GDT净得分与DSf(r=0.203,P=0.214)得分和VFT(r=0.196,P=0.232)得分均无显著相关,而与SCWT(r=-0.384,P=0.016)得分和DSb(r=0.330,P=0.040)得分存在显著相关性。同时负反馈利用率(r=0.599,P0.001)、正反馈利用率(r=0.455,P=0.004)和GDT净得分存在显著相关性。结论面肌痉挛患者在GDT任务,即风险明确情境下的决策功能受损,而在IGT任务,即风险模糊情境下的决策功能相对完整;面肌痉挛患者在风险明确的情境下偏向于高风险选项,且与执行功能(Executive function,EF)、负反馈利用率相关。推测其决策功能障碍可能与背外侧前额叶功能(Dorsolateral Prefrontal Cortex,DLPFC)、执行功能受损有关。
[Abstract]:Objective Hemifacial spasm is a chronic motor disorder caused by neurovascular compression. Long-term discontinuous involuntary facial muscle contraction will inevitably lead to a certain degree of physical and psychological stress, accompanied by varying degrees of anxiety, depression and other emotional problems, long-term stress may even be the cognition of patients. Decision-making is an important part of social cognition and an important function of daily life. This study used Iowa Gambling Task (IGT) to explore the decision-making function of patients with hemifacial spasm in risk-fuzzy situations and Game of Dice Task (GDT) to explore whether the decision-making function of patients with hemifacial spasm changed in risk-specific situations. Methods 44 patients with hemifacial spasm in botulinum toxin therapy clinics and 39 healthy controls matched in age, education and gender were recruited for IGT and GDT. Number of options, total profit of IGT tasks; net score of GDT tasks, i.e. number of non-risk options - number of risk options, total profit of GDT tasks; positive and negative feedback utilization of GDT tasks. We and Word Test (SCWT), Digit Span Test (DS) and Verbal Fluency Test (VFT), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and statistics of the net scores of IGT or GDT tasks related to neuropsychological status in patients with hemifacial spasm Results The net score of GDT in hemifacial spasm group and healthy control group (-4.32+7.906) vs. (3.85+8.502) was statistically significant (t =-4.532, P = 0.000); the negative feedback utilization rate of the two groups (hemifacial spasm group: 32.43 +26.58; healthy control group: 57.19 +32.16) was statistically significant (t =-3.666, P = 0.000). There was no significant difference in the net score of IGT between the two groups (t = - 1.376, P = 0.173); there was no significant difference in the scores of MMSE, SCWT, digit span test (forward), DSf and VFT between the two groups (P 0.05). The scores of test (backward), test (backward), DSb (t = - 3.293, P = 0.001), HAMD (t = 8.367, P = 0.000) and HAMA (t = 7.611, P = 0.000) and HAMA (t = 7.611, P = 0.000) were statistically different. The scores of GDT in patients with spasm were not significantly correlwith those of DSf (r = 0.203, P = 0.203, P = 0.214), VFT (r = 0.196, P = 0.196, P = 0.232), but with SCWT (r = - 0.384, P = 0.384, P = 0.386, P = 0.386, P = 0.016, and B (r = 0.016, r = 0.01P = 0.040) score exists There was significant correlation between negative feedback utilization rate (r = 0.599, P 0.001), positive feedback utilization rate (r = 0.455, P = 0.004) and GDT net score. It is speculated that decision-making dysfunction may be related to dorsolateral prefrontal Cortex (DLPFC) and impaired executive function.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.12

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