基底节缺血性卒中对认知功能的影响

A study on cognitive function after ischemic basal ganglia＇ s stroke

目的探讨基底节缺血性卒中导致的认知功能损害特点。方法基底节缺血性卒中住院患者46例为观察组，所有病例均符1995年10月中华医学会第四届脑血管病学术研讨会通过的脑卒中诊断标准；对照组为性别、年龄和教育程度与观察组相匹配的健康人46例。认知评价采用一般问卷、韦氏成人智力量表的词汇及数字符号测试、韦氏记忆量表、工作记忆课题及威斯康星卡片等，共收集了20项认知功能相关指标。结果观察组的连线作业A[（54．04±5．66）分]、执行完成分类数[（3．56±0．12）分]、执行错误应答数[（16．17±0．58）分]、执行非持续性错误数[（10．17±0．58）分]的得分显著高于对照组（t=4．67，5．03，9．45，9．5；P〈0．01），而词汇测试{（54．21±2．73）分]、经历[（4．52±0．12）分]、定向[（4．65±0．11）分]、视觉再认[（8．34±0．62）分]、图片回忆[（8．13±0．43）分]、视觉再生[（6．957±0．48）分]、触觉记忆[（61．06±9．09）分]、联想学习[（7．39±0．51）分]、顺背[（6．17±0．31）分]、倒背[（3．13±0．14）分]和连线作业B[（122．39±8．28）分]的得分显著低于对照组（P〈0．01）；左右侧基底节缺血性卒中的认知指标显示：在数字符号、定向、执行正确应答数、错误应答数、持续性错误、非持续性错误数6个项目上的差异具有统计学意义（P〈0．05或0．01）；卒中体积与认知功能相关分析：两侧基底节缺血性卒中体积与完成分类数呈正相关（r〉0，P〈0．05），与顺背与倒背呈负相关（r=-0．857，-0．811；P=0．014，0．027）；左侧基底节缺血性卒中体积与词汇测试、经历、视觉再认呈负相关（r=-0．764，-0．907，-0．747；P=0．027，0．002，0．033）；右侧基底节缺血性卒中体积与词汇测试、数字符号、视觉再生、执行完成分类数呈负相关（r=-0．747，-0．770，-0．798；P=0．033，0．026，0．011）。结论基底节缺血性卒中可以引起言语智能、执行功能及记忆等认知功能改变，两侧基底节在操作智能、长时记忆及执行功能方面发挥作用不同，基底节卒中体积越大，认知功能损害越明显。

Objective To find the correlation factors of cognitive disorder after ischemic basal ganglia＇s stroke. Methods 46 cases of ischemic basal ganglia＇s stroked patients by MRI. and 46 cases health control were tested by Wechsler Adult Intelligence Scale （WAIS）, Wechsler Memory Scale （WMS）, Trail Making Test A and B, Wisconsin Card Sorting Test （WCST）. t test, chi-square, two independent samples and spearmancorrelation were used to analyze the data. Results 1 ） Group of thalamic stroke compare with health control for recognition index, there were significant different between the two groups ,there were higher score in the stroke group at trail making test A （ 54.04 ± 5.66 ）, Executive complete number of categories （ Cc ） （ 3.56 ± 0.12 ）, Executive error responsive number （Re） （ 16.17 ± 0.58 ）, non Executive persist error number. Contrary at vocabulary（54.21 ± 2.73 ）, Undergoing （4.52± 0.12 ）, Rotation, Vianal recognition （ 8.34 ± 0.62 ）, Figure recognition （ 8.13 ±0.43 ）, Visual recall （ 6. 957 ± 0.48 ）, Association thinking （ 7.39 ± 0.51 ）, the touch memory （61.06 ± 9.09 ）, Recite （6.17 ± 0.31 ） and Inverse recite （ 3.13 ± 0.14 ）, the＇ trail making test B （ 122.39 ± 8.28 ） （P 〈 0.01 ）. 2 ） Compare of cognition after left and right side basal ganglial stroke ： there were six items of cognition have significant difference, those were Digit symbol, Orientation, Executive complete number of categories （ Cc ）, Executive error responsive number （Re）, non Executive persist error number （nRpe）, Executive persist number （Rp） （P 〈 0.01 ）. 3 ） Correlative analysis：direct and inverted recite negative correlated with stroke volume （ r = - 0. 857, - 0. 811 ; P = 0. 014, 0. 027 ）, Completed number of categories have positive correlation with stroke volume （ r = 0. 822, P = 0.023 ）. The left side stroke correlated with Vocabulary Test, Experience, Visual recognition （ r = - 0. 764, - 0. 907, -0. 747; P= 0.027,0. 002,0. 033 ） ; the right stroke correlated with Vocabulary Test ,Symbolic figure, Visual re- newable, negative correlation with Executive completed number of categories （ r = - 0.747, - 0. 770, - 0. 798 ; P = 0. 033,0. 026,0.011 ）. Conclusion Basal ganglial stroke can cause various cognition disorders,especially in vocabula- ry intelligence,executive function and memory. The different side of basal ganglia＇ s stroke may have different effect on pro- cedure intelligence ,long-term memory and executive function. Stroke volume related with cognition.