四个不同脑部位卒中后记忆功能状况比较

Research of memory impairment following subcortical single strokes in four different parts

目的比较四组脑皮质下单灶卒中患者的认知损害的特点,了解丘脑和基底节的功能,为早期识别血管性认知功能损害(VCI)患者提供依据。方法使用成套神经心理测验评估63例脑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)四个组进行比较,分析不同部位单灶卒中后在听觉词语学习即刻记忆、短延迟记忆、长延迟记忆、再认测试,复杂图形测试和符号数字转换回忆测试上的变化。结果四个部位卒中患者均在AVLT的即刻记忆、短延迟记忆、长延迟记忆和复杂图形测试上与正常组比较,差异均有统计学意义(t分别=3.09、2.81、2.10、2.57;4.69、3.59、3.37、3.83;4.51、3.48、3.02、3.95;2.45、2.02、2.91、2.47,P均<0.05),在AVLT再认上除右丘脑组外,在符号数字转换回忆上除左基底节组外,其余各组与正常组比较,差异均有统计学意义(t分别=3.19、2.28、1.97;3.76、2.67、2.87,P均<0.05)。左丘脑组与右丘脑组及右基底节组在AVLT短延时记忆上比较,差异均有统计学意义(t分别=1.82、1.74,P均<0.05),与右丘脑组在AVLT再认上比较,差异有统计学意义(t=1.77,P<0.05),与左基底节组在符号数字转换回忆上比较,差异有统计学意义(t=2.83,P<0.05)。结论丘脑或基底节受损后记忆功能广泛受损,以左丘脑受损后记忆功能损害最严重。

Objective To study the function of the thalamus and basal ganglia and to identify vascular cognitive impairment（VCI） earlier by comparison of memory impairment following subcortical single strokes in four different areas. Methods A battery of neuropsychological tests, including auditory verbal learning test（AVLT）, rey-osterrieth complex figure test（CFT） and symbol digit modalities test （SDMT）, were performed in 34 normal controls and 63 patients with subcortical stoke. The 63 patients were grouped into left thalamic strokes（n=14）,left basal ganglia strokes（n=17）,right thalamic strokes（n=lS） and right basal ganglia strokes （n=17）. Results Four stroke groups were worse than the controls in AVLT immediate recall, AVLT short-term recall,AVLT long delayed term recall and CFF （t=3.09, 2.81, 2.10, 2.57; 4.69, 3.59, 3.37, 3.83; 4.51, 3.48, 3.02, 3.95; 2.45, 2.02, 2.91, 2.47, P〈0.05）. Excluding right thalamic strokes, all strokes got lower scores than the controls in AVLT recognition test （t=3.19, 2.28,1.97, P〈0.05）. Excluding left basal ganglia strokes, all strokes got lower scores than the controls in SDMT （t=3.76, 2.67,2.87, P〈0.05）. The left thalamic strokes showed worse presence than left thalamic strokes and left basal ganglia strokes in AVLT short-term recall（t=1.82,1.74, P〈0.05 ）, than left thalamic strokes in AVLT recognition（t=1.77, P〈0.05）, than right basal ganglia strokes in SDMT（t=2.83, P〈0.05）. Conclusions Memory function was extensively impaired after thalamus or basal ganglia stroke, especially more severe to left thalamus stroke.