早年创伤对老年轻度认知障碍者学习记忆及事件相关电位的影响

Effect of early trauma on learning- memory and ERP in the elderly with mild cognitive impairment

目的探讨早年创伤性经历与老年轻度认知损害（MCI）患者认知功能的关系。方法从2009～2010年调查的石家庄市社区60岁以上老年人认知功能数据库抽取MCI39例，健康对照37名。采用儿童期创伤问卷一简版（CTQ—RF）进行早年精神创伤评估，情景记忆和联想学习量表进行记忆评估，并进行脑电生理学检测事件相关电位（ERP）。结果两组对象间年龄、性别和受教育程度等一般资料差异无统计学意义（P〉0．05）。MCI组联想学习和情景记忆成绩明显差于健康对照组，差异有统计学意义（Z分别为-3．96，-3．24；P〈0．01）。两组间CTQ-RF量表中仅情感忽视、躯体忽视及总分差异有统计学意义（Z分别为-2．86，-3．19，-3．51；P〈0．01）；余因子分以及生活事件评分未见统计学意义（P〉0．05）。经Spearman单因素相关分析，结果显示情感虐待、躯体忽视和CTQ总分与联想学习呈正相关（r分别为0．38，0．86，0．63；P〈0．05），余未见相关性。MCI组Cz点、Pz点P300和N200潜伏期明显长于健康对照组，Cz点、Pz点P300和N200波幅明显低于健康对照组，差异有统计学意义（P〈0．05）。经Spearman单因素相关分析，结果显示仅躯体忽视和CTQ-RF总分与Fz点N200、Pz点N200的潜伏期呈正相关（P〈0．05），与Pz点P300波幅呈负相关（P〈0．05）。结论早年创伤能够导致老年期学习记忆功能下降尤其是联想学习和情景记忆，童年期情感虐待、躯体忽视与其密切相关。

Objective To explore the relationship between early traumatic experience and cognitive function in the elderly with mild cognitive impairment. Methods Totals of 39 cases over 60 years old, who were randomly selected from MCI database from 2009 to 2010 in Shijiazhuang city community,and healthy control group（37 cases）. The subjects were evaluated by Childhood Trauma Questionnaire-- Brief Version（CTQ--RF） for early trauma, and episodic memory and association learning scale for mem- ory evaluation, and brain electrophysiological for event--related potential（ERP）. Results Between the two groups of subjects such as age, gender and level of education and other general information had no statistical significance （P ~ 0.05）. By rank sum test, associative learning and episodic memory scores of MCI group was significantly lower than those of healthy control group, the difference was statistically significant （Z =--3.96, --3.24,respectively; P ~ 0.01）. CTQ--RF scale between the two groups only in emotional neglect, physical neglect and CTQ--RF total score difference was statistically significant （Z = - 2.86, -3.19,-3.51, respectively; P 〈0.01） ; Cofactor points and life events scores had no statistical significance （P〉 0.05）. The Spearman correlation univariate analysis showed that the emotional abuse, physical neglect and CTQ total score was positively correlated with associative learning （r = 0.38, 0.86, 0.63respectively; P 〈 0.05）, and no correlation with other factors. The latency of P300 and N200 in Cz and Pz in MCI group was longer than that of healthy control group, The amplitude of P300 and N200 in Cz and Pz in MCI group was lower than the healthy control group, the difference was statistically signifi- cant （P 〈 0.05）. It showed that only physical neglect, CTQ score was positively correlated with latency of N200 in Fz and Pz, and negatively correlated with amplitude of P300 in Pz by Spearman correlation analysis. Conclusions Early trauma can lead to decline on learning and memory in the elderly, especially associative learning and episodic memory, which is closely related to emotional abuse and physical neglect in childhood.