急性卒中后运动性失语患者的非语言认知损伤分析

Analysis of Non-linguistic Cognitive Impairment in Acute Stroke Patients with Broca’s Aphasia

目的分析急性卒中后运动性失语患者的非语言认知损伤特点,以及语言障碍与非语言性认知功能损害之间的关系。方法前瞻性入组2019年4月-2021年4月在首都医科大学附属北京天坛医院神经病学中心住院的急性卒中后运动性失语患者和非失语患者,采用西方失语症成套测验(western aphasia battery,WAB)评估语言功能,洛文斯顿成套测验(Loewenstein occupational therapy cognitive assessment,LOTCA)中文版第2版评估非语言认知功能。比较运动性失语和非失语组的LOTCA分值;对运动性失语组WAB的分项与LOTCA各认知分项和总分进行偏相关分析,进一步应用多元线性回归分析WAB分项对LOTCA总分的影响,根据结果构建回归方程并对回归方程进行拟合优度检验和显著性检验。结果本研究共纳入运动性失语21例,非失语患者14例。运动性失语组的LOTCA总分(P<0.001)及定向(P<0.001)、视知觉(P<0.001)、空间知觉(P=0.007)、动作运用(P=0.006)、视运动组织(P<0.001)、思维操作(P<0.001)和注意力(P=0.010)分项的分值均低于非失语组患者。偏相关分析显示,LOTCA总分与WAB中失语商(r=0.619,P=0.003)、自发言语(r=0.518,P=0.016)和听理解(r=0.716,P<0.001)呈线性正相关。多元线性回归分析显示,自发言语(P=0.003)、听理解(P<0.001)是LOTCA总分的影响因素。基于回归方程建立模型:LOTCA总分=0.442×自发言语+0.643×听理解,对回归方程进行拟合优度检验及显著性检验。结果显示该回归方程调整后R2值为0.682,显著性检验F=22.434,P<0.001,具有统计学意义。结论急性卒中后运动性失语患者在定向、视知觉、空间知觉、动作运用、视运动组织、思维操作和注意力方面均存在不同程度的障碍,语言测试中的自发言语和听理解是非语言认知功能的独立影响因素。

Objective To explore the characteristics of non-linguistic cognitive impairment in acute stroke patients with Broca’s aphasia,and the relationship between language impairment and non-linguistic cognitive impairment.Methods This study prospectively enrolled acute stroke patients with Broca’s aphasia and nonaphasia who were hospitalized in Department of Neurology of Beijing Tiantan Hospital,Capital Medical University from April 2019 to April 2021.The western aphasia battery(WAB)was used to assess language impairment and the second edition of Loewenstein occupational therapy cognitive assessment(LOTCA)was used to assess non-linguistic cognitive function.The LOTCA scores of Broca’s aphasia and non-aphasia groups were compared.Partial correlation analysis was carried out on the sub-items of WAB with each cognitive sub-item and total score of LOTCA in Broca’s aphasia group.The multivariate stepwise linear regression model was used to analyze the influence of WAB sub-items on the total score of LOTCA,to construct the regression equation according to the results.The goodness-of-fit test and significance test were performed on the regression equation.Results A total of 21 patients with Broca’s aphasia and 14 patients with non-aphasia were enrolled in this study.The total LOTCA score(P<0.001)and scores of orientation(P<0.001),visual perception(P<0.001),spatial perception(P=0.007),motor praxis(P=0.006),visuomotor organization(P<0.001),thinking operation(P<0.001),and attention(P=0.010)in Broca’s aphasia group were lower than those in non-aphasia group.Partial correlation regression analysis showed that the total LOTCA score was positively correlated with aphasia quotient(r=0.645,P=0.002),spontaneous speech(r=0.518,P=0.016)and comprehension(r=0.716,P<0.001)in WAB.Multivariate linear regression analysis showed that spontaneous speech and comprehension scores in WAB were the main influencing factors of the total score of LOTCA.The regression equation as follows:LOTCA total score=0.442×spontaneous speech+0.643×comprehension.The result of the goodness-of-fit and significance test showed the adjusted R2 value was 0.682,and F=22.434,P<0.001.Conclusions Acute stroke patients with Broca’s aphasia have impairment in orientation,visual perception,spatial perception,motor praxis,visuomotor organization,thinking operation,and attention.Spontaneous speech and comprehension in language test are independent influencing factors of non-linguistic cognitive function.