多发性硬化患者信息处理速度及影响因素

Information processing speed and influential factors in multiple sclerosis

目的 探讨多发性硬化（MS）患者信息处理速度及其影响因素.方法 收集2010年4月至2012年4月在首都医科大学宣武医院神经内科就诊的复发缓解型MS患者（RRMS） 36例,继发进展性MS患者（SPMS）21例,健康对照50名作为研究对象.在病情稳定8周后采用数字-符号转换测验（SDMT）、中文版听觉数字连续加法测试（PASAT）进行信息处理速度测定,并评估患者记忆力、执行功能及其他认知功能.对所有研究对象进行抑郁状态、疲劳、睡眠质量及日常生活能力评估.结果 （1） RRMS组和SPMS组患者均有认知功能下降,以信息处理速度下降最为明显,其中SDMT测验[健康对照（57±12）分;RRMS组（46±17）分;SPMS组（35±10）分,P＜0.05],PASAT测验总评分[健康对照（85±18）分;RRMS组（77±20）分;SPMS组（57±20）分,P＜0.05],SPMS组平均成绩明显差于RRMS组,采用EDSS评分纠正躯体残疾的干扰后,两组之间的差异缩小.RRMS组及SPMS组言语性记忆测查中的即刻记忆、延迟回忆及再认较对照组差,而两组患者之间未见显著性差异;与对照组相比,MS患者执行功能测查中语义流畅性测验成绩下降,Stroop C部分测验反应时间明显延长,SPMS更为显著;视空间功能、视觉记忆相对保留.（2）Pearson单因素相关分析,Hamilton抑郁量表评分、疲劳、年龄、EDSS评分、白质病灶分级及复发次数与信息处理速度成绩呈负相关（r=-0.41～-0.61,P＜0.05）.将研究对象分为抑郁组、无抑郁组,抑郁组信息处理速度明显差于无抑郁组（P＜0.05）.结论 MS患者信息处理速度下降明显,并可出现言语性记忆及执行功能下降,视空间功能相对保留.抑郁、年龄、EDSS评分及白质病灶分级与信息处理速度呈负相关.

Objective To study the information processing speed and the influential factors in multiple sclerosis （MS） patients.Methods A total of 36 patients with relapsing-remitting MS （RRMS）,21 patients with secondary progressive MS （SPMS）,and 50 healthy control subjects from Xuanwu Hospital of Capital Medical University between April 2010 and April 2012 were included into this cross-sectional study.Neuropsychological tests was conducted after the disease had been stable for 8 weeks,including information processing speed,memory,executive functions,language and visual perception.Correlation between information processing speed and depression,fatigue,Expanded Disability Status Scale （EDSS） were studied.Results （1） MS patient groups demonstrated cognitive deficits compared to healthy controls.The Symbol Digit Modalities Test （SDMT） （control group 57 ± 12;RRMS group 46 ± 17;SPMS group 35± 10,P ＜ 0.05） and Paced Auditory Serial Addition Task （PASAT） （control group 85 ± 18;RRMS group 77 ± 20;SPMS group 57 ± 20,P ＜ 0.05） impaired most.SPMS patients were more affected compared to patients with RRMS subtypes,and these differences were attenuated after control for physical disability level as measured by the EDSS scores.MS patients,especially SPMS subtype,were more severely impaired than control group in the verbal learning test,verbal fluency,Stroop C test planning time,while visual-spatial function and visual memory were relatively reserved in MS patients.（2） According to the Pearson univariate correlation analysis,age,depression,EDSS scores and fatigue were related with PASAT and SDMT tests （r =-0.41--0.61,P ＜ 0.05）.Depression significantly affected the speed of information processing （P ＜0.05）.Conclusions Impairment of information processing speed,verbal memory and executive functioning are seen in MS patients,especially in SPMS subtype,while visual-spatial function is relatively reserved.Age,white matter change scales,EDSS scores,depression are negatively associated with information processing speed.