小脑与认知关系的初步临床研究
发布时间：2018-09-13 08:06
【摘要】：目的本研究主要通过对小脑半球及蚓部病变患者进行神经心理及情感测评,并结合头颅MRI探讨小脑不同部位的认知作用,探索小脑与认知间更深层次的联系,为今后针对小脑病变的诊治、康复和预后提供相关依据。 方法以2013年3月至2014年3月我院神经内科及神经外科收治的不同部位小脑病变(小脑梗死、小脑出血、小脑占位性病变)患者21例作为病例组；同时随机选取临床及影像学检查无任何神经系统异常者21例作为对照组。病例组在发病后10-30天内病情稳定,能完成所有认知功能测验。病例组和对照组均采用蒙特利尔认知评估量表(MoCA)进行认知的总体评估；Rey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)进行记忆功能评估；符号-数字模式测验(SDMT)、线段等分测验(TLBT)、连线测试(TMT)进行视空间功能评估；威斯康星卡片分类测试(WCST)进行执行功能评估；汉语失语症检查量表(CAES)进行语言功能评估；汉密尔顿抑郁量表(HAMD)、神经精神问卷(NPI)进行情绪认知评估。应用3.0T核磁共振扫描系统对小脑左右侧半球病变患者行全脑磁共振成像,使用软件MRIcron在标准层模板上将所有边缘清晰的T1成像病灶进行重叠。采用SPSS17.0软件对数据进行统计分析。 结果(1)小脑病例组与对照组比较,病例组MOCA、AVLT、DST、指向记忆、联想学习、图像自由回忆、无意义图形再认、人物特点回忆、总记忆商、SDMT、TLBT、 CC、RCP、RFP、语言理解、命名得分均显著低于对照组,TMT、RE、RP、nRPE、HAMD、NPI得分均显著高于对照组(P0.01,P0.05)。(2)小脑病例组中,左侧半球病变、右侧半球病变及蚓部病变三组比较,左侧半球病变组联想学习得分高于右侧半球病变组(P0.05)；左侧半球病变组TLBT、RCP、RFP得分均显著低于右侧半球病变组及蚓部病变组,RF得分显著高于右侧半球病变组及蚓部病变组(P0.01,P0.05)；右侧半球病变组RP、nRPE得分均显著高于左侧半球病变组及蚓部病变组,语言理解、命名得分均显著低于左侧半球病变组及蚓部病变组(P0.01,P0.05)；蚓部病变组HAMD、NPI得分均显著高于左侧半球病变组及右侧半球病变组(P0.01)。 结论(1)小脑参与了部分认知的形成过程,小脑病变后不同认知功能—记忆、视空间、执行功能、语言功能、情绪认知均有不同程度的下降。(2)小脑单侧或蚓部病变均使记忆、视空间、执行功能、语言功能、情绪认知产生不同程度的受损。(3)小脑不同部位病变后认知损害存在差异—左侧小脑半球病变后视空间、抽象概括能力、概念形成能力受损严重；右侧小脑半球病变后注意力、认知转移能力受损严重；小脑蚓部病变后情绪认知受损严重。(4)在右利手患者中,右侧小脑半球病变后语言功能受损严重。
[Abstract]:Objective to explore the deeper relationship between cerebellum and cognition by measuring neuropsychology and emotion in patients with cerebellar hemisphere and vermis lesions, and exploring the cognitive function of different parts of cerebellum with MRI. To provide relevant evidence for the diagnosis, treatment, rehabilitation and prognosis of cerebellar lesions in the future. Methods from March 2013 to March 2014, 21 patients with cerebellar lesions (cerebellar infarction, cerebellar hemorrhage, cerebellar space occupying lesion) were treated in neurology and neurosurgery department of our hospital. At the same time, 21 cases with no abnormal nervous system were randomly selected as control group. The patient group was stable within 10-30 days and could complete all cognitive function tests. Both the case group and the control group were assessed with the Montreal Cognitive Assessment scale (MoCA) for the overall assessment of cognition. (AVLT), (AVLT), digital memory span test (DST), clinical memory scale (CMS) were used to evaluate the memory function. (SDMT), line segment equipartition test (TLBT), connection test (TMT) for visual spatial function evaluation Wisconsin card sorting test (WCST) for executive function evaluation Chinese aphasia scale (CAES) for language function evaluation; Hamilton Depression scale (HAMD),) Neuropsychiatric questionnaire (NPI) was used to assess emotion cognition. The left and right hemisphere lesions of the cerebellum were studied by using 3.0T MRI system. All T1 lesions with clear edge were overlapped on the standard layer template by software MRIcron. The data were analyzed by SPSS17.0 software. Results (1) compared with the control group, the cerebellar case group showed that MOCA,AVLT,DST, directed memory, associative learning, image free recall, meaningless pattern recognition, character feature recall, total memory quotient SDMTT TLBT, CC,RCP,RFP, language comprehension. The nomenclature scores were significantly lower than those in the control group (P 0.01). (2), and the scores of the left hemisphere lesion, the right hemisphere lesion and the vermis lesion were significantly higher than those in the control group. The scores of association learning in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group (P0.05), and the TLBT,RCP,RFP scores in the left hemisphere lesion group were significantly lower than those in the right hemisphere lesion group and the vermis lesion group (P 0.05), and the RF scores in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group and the right hemisphere lesion group (P 0.05). The RP,nRPE scores in the right hemisphere lesion group were significantly higher than those in the left hemisphere lesion group and the vermis lesion group. The language understanding and naming scores were significantly lower in the right hemisphere lesion group than in the left hemisphere lesion group and the vermis lesion group (P 0.05). The HAMD,NPI scores in the vermis lesion group were significantly higher than those in the left hemisphere lesion group and the right hemisphere lesion group (P0.01). Conclusion (1) the cerebellum is involved in the formation of partial cognition, and different cognitive functions, such as memory, visual space, executive function, language function and emotional cognition, are decreased in different degree after cerebellar lesion. Visual space, executive function, language function and emotional cognition are impaired to different degrees. (3) there are differences in cognitive impairment in different parts of cerebellum-posterior space of left cerebellar hemispheres, abstract generalization ability and impaired ability of concept formation; In the right cerebellar hemisphere, the ability of cognitive transfer was seriously impaired, and the emotional cognition was seriously impaired after the lesion of cerebellar vermis. (4) in the patients with right-handed hand, the speech function of the right cerebellar hemisphere was seriously impaired after the lesion of the right cerebellar hemisphere.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741
[Abstract]:Objective to explore the deeper relationship between cerebellum and cognition by measuring neuropsychology and emotion in patients with cerebellar hemisphere and vermis lesions, and exploring the cognitive function of different parts of cerebellum with MRI. To provide relevant evidence for the diagnosis, treatment, rehabilitation and prognosis of cerebellar lesions in the future. Methods from March 2013 to March 2014, 21 patients with cerebellar lesions (cerebellar infarction, cerebellar hemorrhage, cerebellar space occupying lesion) were treated in neurology and neurosurgery department of our hospital. At the same time, 21 cases with no abnormal nervous system were randomly selected as control group. The patient group was stable within 10-30 days and could complete all cognitive function tests. Both the case group and the control group were assessed with the Montreal Cognitive Assessment scale (MoCA) for the overall assessment of cognition. (AVLT), (AVLT), digital memory span test (DST), clinical memory scale (CMS) were used to evaluate the memory function. (SDMT), line segment equipartition test (TLBT), connection test (TMT) for visual spatial function evaluation Wisconsin card sorting test (WCST) for executive function evaluation Chinese aphasia scale (CAES) for language function evaluation; Hamilton Depression scale (HAMD),) Neuropsychiatric questionnaire (NPI) was used to assess emotion cognition. The left and right hemisphere lesions of the cerebellum were studied by using 3.0T MRI system. All T1 lesions with clear edge were overlapped on the standard layer template by software MRIcron. The data were analyzed by SPSS17.0 software. Results (1) compared with the control group, the cerebellar case group showed that MOCA,AVLT,DST, directed memory, associative learning, image free recall, meaningless pattern recognition, character feature recall, total memory quotient SDMTT TLBT, CC,RCP,RFP, language comprehension. The nomenclature scores were significantly lower than those in the control group (P 0.01). (2), and the scores of the left hemisphere lesion, the right hemisphere lesion and the vermis lesion were significantly higher than those in the control group. The scores of association learning in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group (P0.05), and the TLBT,RCP,RFP scores in the left hemisphere lesion group were significantly lower than those in the right hemisphere lesion group and the vermis lesion group (P 0.05), and the RF scores in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group and the right hemisphere lesion group (P 0.05). The RP,nRPE scores in the right hemisphere lesion group were significantly higher than those in the left hemisphere lesion group and the vermis lesion group. The language understanding and naming scores were significantly lower in the right hemisphere lesion group than in the left hemisphere lesion group and the vermis lesion group (P 0.05). The HAMD,NPI scores in the vermis lesion group were significantly higher than those in the left hemisphere lesion group and the right hemisphere lesion group (P0.01). Conclusion (1) the cerebellum is involved in the formation of partial cognition, and different cognitive functions, such as memory, visual space, executive function, language function and emotional cognition, are decreased in different degree after cerebellar lesion. Visual space, executive function, language function and emotional cognition are impaired to different degrees. (3) there are differences in cognitive impairment in different parts of cerebellum-posterior space of left cerebellar hemispheres, abstract generalization ability and impaired ability of concept formation; In the right cerebellar hemisphere, the ability of cognitive transfer was seriously impaired, and the emotional cognition was seriously impaired after the lesion of cerebellar vermis. (4) in the patients with right-handed hand, the speech function of the right cerebellar hemisphere was seriously impaired after the lesion of the right cerebellar hemisphere.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741
【共引文献】
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