基底节区卒中对内隐学习的影响

The effects of basal ganglia stroke on implicit learning

目的探讨基底节区卒中患者内隐学习损害的特征以及受损的状况。方法基底节区卒中患者17例，其中左侧基底节区卒中组8例，右侧基底节区卒中组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。采用天气预报分类学习任务（WPCLT）、威斯康星卡片分类（WCST）分别对左右侧基底节损伤患者和对照组进行连续3d的测试。结果右侧基底节卒中组连续3d的WPCLT总正确率和正常对照组相比均差异具有显著性[（52．72±5．57）％，（61．85±8．49）％，F=3．55，P=0．048；（55．83±4．52）％，（71．85±10．89）％，F=7．74，P=0．003；（62．33±7．70）％，（80．15±6．67）％，F=10．96，P=0．001]，左侧基底节组在第3天的测试中WPCLT总正确率显著差于正常对照组（F=10．96，P=0．009）。左右侧基底节卒中患者的WPCLT学习能力均明显低于正常对照组（F=12．42，P〈0．01）。正常对照组在第2天的测试中WPCLT总分与WCST的完成分类数有显著相关，在第3天的测试中WPCLT总分与WCST的错误率和完成分类数有显著相关。结论基底节区卒中的患者内隐学习受损，且内隐-外显的学习模式也受损。

Objectives To gain a deeper understanding of the role of the basal ganglia in implicit learning by examining Weather Prediction Category Learning Task among patients with basal ganglia stroke. Methods Seventeen patients with basal ganglia stroke including eight cases of left basal ganglia lesions and nine eases of right basal ganglia lesions. Ten cases without brain damage were used as control. All of the subjects were tested by use of Weather Prediction Category Learning Task （WPCLT） and Wisconsin Card Sorting Test （WCST） in 3 consecutive days. Results The patients with right basal ganglia lesions were consistently impaired compared with the controls（（52.72±5.57）% vs （61.85±8.49）%, F=3.55, P=0.048）;（55.83±4.52）% vs （71.85±10.89）%, F=7.74, P=0.003） ;（62.33 ±7.70）% vs （80.15 ±6.67）%, F= 10.96, P=0. 001）） ,and the patients with right basal ganglia lesions were impaired in the last day（F= 10.96, P=0. 009）. But in patients of left and right basal ganglia lesions, the learning potential of WPCLT decreased significantly compared with the control （P 〈 0.01 ）. In the control group, the WPCLT total number of correct and WCST Number of Categories Completed were highly related in the second day. The WPCLT total number of correct correlated significantly with Percent Errors and Number of Categories Completed of WCST in the third day. Conclusion The basal ganglia lesions may decrease implicit learning, and the bottom-up （implicit-to-explicit） learning pattern is impaired in patients with basal ganglia lesions.