发作性头痛与慢性头痛患者神经心理学与注意功能影响的初步研究

A preliminary study of neuropsychological and attentional function in patients with episodic headache and chronic headache

目的:探讨发作性头痛与慢性头痛患者注意功能影响的临床表现及其可能的作用机制。方法:通过纳入18例发作性头痛(episodic headache,EH)患者、20例慢性头痛(chronic headache,CH)患者和21例健康对照人群,分别进行神经心理学评估,包括简易精神状态评估量表(mini mental state exam,MMSE)、蒙特利尔认知评估量表中国北京版(Beijing Chinese version of Montreal Cognitive Assessment,Mo CA-C)、数字广度测试(digit span test,DS)、额叶功能评定量表(frontal assessment battery,FAB)、医院焦虑抑郁量表(hospital anxiety and depression subscales,HADS)和匹兹堡睡眠量表(Pittsburgh sleep quality index,PSQI)和注意力网络测试(attention networks test,ANT),并进行对比分析。结果:CH组的Mo CA-C(P值均<0.001)、DS(P=0.002或P=0.004)、HADS(焦虑:P<0.001或P=0.002;抑郁:P<0.001或P=0.001)、PSQI(P<0.001或P=0.001)评估结果均与健康对照组或EH组存在显著差异。CH组和健康对照组的FAB评估结果亦存在显著差异(P=0.021)。ANT测试结果显示3组间的警觉、定向效率和正确率无显著差异,但CH组的平均反应时间较健康对照组或EH组明显延长(P=0.002或P=0.035),执行控制效率较健康对照组明显降低(P=0.042)。结论:头痛损害注意功能,而CH组损害更明显,主要表现为CH患者执行注意力相关任务的平均反应时间延长、执行控制功能降低,提示CH损害了注意网络-执行功能,该功能的损害可能是头痛损害注意功能的关键机制之一。

Objective：To investigate the clinical features and possible mechanisms of attention function in patients with episodic headache and chronic headache. Methods：Through a total of 18 patients with Episodic Headache（EH）,20 patients with chronic headache（CH）and 21 healthy controls,respectively,neuropsychological assessment including mini mental state assessment scale（mini mental state exam,MMSE）,Montreal cognitive assessment（China-Beijing edition Beijing Chinese version of Montreal Cognitive Assessment,Mo CA-C）,digital span test（digit span test,DS）,frontal lobe function rating scale（frontal assessment battery,FAB）,the hospital anxiety and Depression Scale（hospital Anxiety and depression subscales,HADS）and Pittsburgh Sleep Scale（Pittsburgh sleep quality index,PSQI）and attention network test（attention networks test,ANT）,and comparative analysis. Results：There were significant differences in Mo CA-C（P〈0.001 or P〈0.001）,DS（P=0.002 or P=0.004）,HADS（anxiety：P〈0.001 or P=0.002;depression：P〈0.001 or P=0.001）and PSQI（P〈0.001 or P=0.001）between chronic headache and episodic headache or healthy controls. Significant difference was also found in FAB between chronic headache and healthy control（P=0.021）. ANT showed that there were no significant differences in alerting,orienting or accuracy among three groups,but median response time was prolonged significantly in patients with chronic headache than those with episodic headache or healthy controls（P=0.002 or P=0.035）,and compared with healthy controls,executive control function was also disrupt in chronic headache patients（P=0.042）. Conclusion：Headache does disrupt attention function,especially in chronic headache,mainly for the average reaction time to perform tasks related to CH patients with prolonged attention,executive function decreased,suggesting that CH damaged the attention network-executive function,and these might be one of the key mechanisms of headache disrupting attention.