四种不同脑部位卒中后认知功能状况比较

A comparison study on cognitive function in patients with single subcorticai lesion stroke of four different areas

目的比较4种皮质下单灶性卒中患者的认知损害的特点，了解丘脑和基底节的认知功能，为早期识别血管性认知功能损害（VCI）患者提供依据。方法使用成套的神经心理测验评估63例皮质下单灶卒中患者和34名健康对照组，病例组患者分为左丘脑卒中组（14例）、左基底节卒中组（17例）、右丘脑卒中组（15例）和右基底节卒中组（17例）4个组进行比较，5个组别的年龄、性别、教育程度比较差异无统计学意义。结果（1）在记忆、注意／执行功能、语言能力、空间功能等存在广泛的认知功能损害，病例组明显差于对照组（P〈0．05）。（2）与其他3个卒中组相比，左侧丘脑卒中组在言语功能（BNT：16．6分±2．6分）、听觉即刻回忆（12．8个±4．4个）、听觉长延迟记忆回忆（2．4个±2．3个）、听觉再认（19．1个±3．1个）、结构延迟记忆（9．1分±4．7分）、SDMT偶然记忆（0．9分±1．1分）方面都比较差，左丘脑的损害对认知功能影响最严重（P〈0．05）。（3）左基底节组患者在与右手操作相关的项目（TMT-A耗时数75S±22S、TMT—B耗时数204s±81s、CDT23．5分±4．6分、SDMT24个±9个）表现优于另外3个卒中组，而接近健康对照组（P〈0．05）。结论卒中后认知功能可能存在一般的、非选择性的认知功能损害，同时，不同部位卒中所致认知损害各有特点，其中左丘脑卒中相对最为严重，而左基底节卒中后右手的功能训练有助于改善操作相关的心理测验的表现。

Objective Comparing the characteristics of cognitive impairment of patients with single subcortical lesion stroke of four different areas, we are to explore the cognitive function of the thalamus and basal ganglia and this is help for early identification of vascular cognitive impairment（VCI）. Methods 63 patients with single subcortical lesion stroke（ including 14 left thalamic stoke group, 17 left basal ganglia stroke group, 15 right thalamic stroke group, 17 right basal ganglia stroke group） and 34 healthy subjects participated in the current study, whose age, sex and education were matched. A comprehensive neuropsychological battery was used for evaluation. Results Compared to the normal control group, there was an overall decline of cognitive functions in patients with single subcortical lesion stroke in memory, attention/executive function, language, and visuospatial ability （P 〈 0. 05 ）. The scores of the left thalamic stroke group were worse than the other three stroke groups in language （ BNT16. 6 ± 2. 6 ） , auditory verbal learning test-immediate recall （ 12. 8 ± d. 4 ）, auditory verbal learning test-delayed recall （ 2.4 ± 2.3 ）, listening recognition （ 19.1 ± 3.1 ） , structure delayed recall （9.1 ± 4. 7 ） and symbol digit modalities testrecall （0. 9 ± 1.1 ） （P 〈 0. 05）. However, the left basal ganglia stroke group did better in tests manipulated by the right hand [ including Trial making test （part A） score （75 ± 22） ,Trail making test （part B） score （204 ±81）, Clock drawing test （23.5 ± 4. 6）, Symbol digit modalities test （24 ± 9）] than other three stroke group, as good as the normal group（P 〈 0.05）. Conclusions Single subcortical stroke patients may have general, non-selective cognitive impairment. But, different stroke areas have their own characteristics. The scores of the left thalamic stroke group were worse than the other three stroke groups.