基底核卒中对执行功能和学习能力的影响

The effects of basal ganglia stroke on executive function and learning potential

目的:探讨基底核卒中执行功能损害的特征及学习能力受损的状况,为康复策略的制定提供理论基础。方法:基底核卒中患者17例,其中左侧基底核卒中组8例,右侧基底核卒中组9例。同期住院的非脑部疾病的患者或无任何疾病的健康者10例。采用汉诺塔(TOH)、威斯康星卡片分类(WCST)、连线测试(TMT)和音素言语流畅度(PVF)分别对左、右侧基底核损伤患者和对照组进行连续3d的测试。结果:基底核卒中组在学习前TOH时间、WCST错误率、完成分类数、TMT-A和TMT-B测试时间显著差于对照组。左、右基底核比较显示学习前右侧基底核卒中组在TOH时间和WCST保持性反应率显著差于左侧基底核卒中组。左侧基底核卒中组中WCST保持反应率和PVF学习能力显著受损;右侧基底核损伤组中WCST完成分类数的学习能力显著降低。结论:基底核卒中表现有多项执行功能障碍,但保留一定的学习能力,学习能力的类型和程度在左、右基底核有所不同,提示根据基底核卒中的部位选择认知康复训练项目可以提高运动疗法的康复效果。

Objective： To explore the effects of basal ganglia stroke on executive function and learning potential, and provide the theoretical foundation for rehabilitation strategy. Method： Seventeen patients with basal ganglia stroke contained 8 cases with left basal ganglia lesions and 9 cases with fight basal ganglia lesions. Ten eases were used as control group which were selected from people in good health or the same-period patients in hospital without brain damage. The executive function and learning potential in all subjects were tested by use of Tower of Hanoi （TOH）, Wisconsin Card Sorting Test （WCST）, Trail Making Tests （TMT） and Phonemic Verbal Fluency （PVF） for 3 consecutive days. Result： In comparison to control group, time of TOH, percent errors of WCST, TMT-A and TMT-B increased significantly and number of Categories Completed of WCST decreased significantly before learning in patients with basal ganglia lesions. In comparison to patients with left basal ganglia lesions, percent perseverative responses of WCST and time of TOH increased significantly before learning in patients with right basal ganglia lesions. In patients with left basal ganglia lesions, the learning potential of percent perseverative responses of WCST increased significantly compared with control group and patients with right basal ganglia lesions, and the learning potential of PVF decreased significantly compared with control group. In patients with fight basal ganglia lesions, the learning potential of number of Categories Completed decreased significantly compared with control group. Conclusion： The basal ganglia stroke may retain certain learning potential in spite of executive functional impairment. The category and extent of learning potential displayed in basal ganglia lesions of left and right are not alike, which suggest that selecting opportune cognitive training programs in accordance with the site of basal ganglia lesions may raise effects of exercises therapy.