脑白质病变患者的情景记忆监测

The episodic memory monitoring in patients with white matter lesions

目的研究脑白质病变 （white matter lesion, WML）患者的情景记忆监测，进一步探讨WML患者情景记忆障碍与记忆监测的相关性及可能机制。方法采用情景记忆“知道感”（ feeling of knowing-episodic memory, FOK-EM）判断的试验范式任务，对30例WML患者和30例存在头晕、记忆障碍，年龄及受教育程度相匹配的同期就诊对照者进行研究。结果与对照组的FOK．EM的线索回忆成绩（4．37±1．59）、再认成绩（8．73±1．05）相比，WML患者组的线索回忆成绩（3．30±1．51）、再认成绩（7．23±0．77）显著降低，差异有统计学意义（t=2．666，P〈0．05；t=6．306，P〈0．01）；WML患者组的FOK判断准确度（-0．13±0．31）、肯定判断／正确再认成绩（23．16％±5．96％）、肯定判断／错误再认成绩（高估，34．26％±7．65％）较对照组的FOK判断准确度（0．34±0．27）、肯定判断／正确再认成绩（35．12％±6．82％）、肯定判断／错误再认成绩（19．27％±6．50％）差异有统计学意义（t=6．280、7．234、-8．174，均P〈0．01）；且肯定判断／错误再认成绩与脑室旁及深部白质病变的严重程度均呈正相关（r=0．716，P〈0．01；r=0．598，P〈0．01）。结论WML患者的情景记忆监测受损，表现为对再认能力的高估，这种记忆监测的受损与前额叶．皮质下环路受损引起的执行功能障碍有关，提示此机制可能是导致WML患者情景记忆障碍的重要因素。

Objective To investigate the episodic memory monitoring in patients with white matter lesions （WML） and explore the relevance of episodic memory disorder and memory monitoring and the possible mechanism. Methods The feeling of knowing-episodic memory （FOK-EM） paradigm was adopted and subsequently administered in 30 WML patients and 30 control participants who were matched in age and educational level. Results Compared with control group （ cued recall 4.37 ± 1.59 ; recognition 8.73 ± 1.05 ）, the episodic memories of WML patients were significantly impaired on the cued recall performance （3.30 ± 1.51, t = 2. 666, P 〈 0.05 ） and recognition performance （7.23 ＋ 0.77, t = 6. 306, P 〈 0.01 ）. Furthermore, the accuracy of FOK judgment （ -0.13 ± 0.31 ） , the correct judgment and correct recognition of FOK-EM （23.16% ±5.96% ） and the correct judgment and false recognition of FOK-EM （34.26% ± 7. 65% ） in the WML patients group were significantly different compared with the control group （the accuracy of FOK judgment： 0. 34 ± 0. 27, t = 6. 280, P 〈 0. 01; the correct judgment and correct recognition： 35. 12% ±6. 82%, t =7. 234, P 〈0.01; the correct judgment and false recognition： 19.27% ±6.50%, t = - 8. 174, P 〈 0.01 ）. In addition, the correct judgment and false recognition performance were positively correlated with the severity of periventricular lesions and deep white matter lesions in the WML patients group （r=0.716, P〈0.01 ; r =0.598, P〈0.01）. Conclusions The WML patients demonstrated an overestimation of their recognition ability of episodic memory. Moreover, thisimpairment of memory monitoring was correlated with the deficit of executive function caused by the damage of the prefrontal-subcortical circuit, indicating that this mechanism could be an influential factor of episodic memory disorder in WML.