帕金森病患者风险决策能力研究

目的 探讨帕金森病( Parkinson' disease,PD)患者在风险概率明确条件下的决策能力是否改变,进一步研究基底节与决策的关系.方法 采用风险概率明确的骰子博弈测试( Game of Dice Test,GDT)对25例PD患者(PD组)和25名健康被试者(HC组)进行风险决策能力研究.结果 与HC组(5.72±3.69)相比,PD组(10.88±5.58)更倾向于选择风险选项(t=3.86,P＜0.01).PD组(-3748.00±3923.87)的最后总资产通常是负值,而HC组(684.00±1764.62)都有盈利,两者的差异有统计学意义(t=-5.15,P＜0.01).PD组选择最多的是风险最大的选项即1个数字,而HC组选择最多的是3个数字的联合(1个数字:PD组:6.48±5.81;HC组:1.00±1.44;t=4.58,P＜0.01；3个数字:PD组:2.64±2.14;HC组:7.04±2.54；t=-6.62,P＜0.01),差异有统计学意义.此外,选择风险选项的次数与负反馈利用率(r=-0.59,P=0.003)和Stroop结果(r=0.55,P=0.004)的相关性显著.结论 研究表明PD患者在风险概率明确条件下存在明显的决策能力改变,并与执行功能和负反馈利用率相关.     

早期未治疗帕金森病患者情绪记忆损害的特点

目的 探讨早期未治疗帕金森病(PD)患者情绪记忆损害的特点。方法 利用标准的情绪图片(包括正性、负性和中性效价)对33例PD患者和31名年龄、性别和教育程度相匹配的健康对照组进行情绪记忆测试。结果 与对照组[负性(13.4±1.4)分]相比,PD组[(8.9±1.0)分]负性情绪效价图片再认成绩差异有统计学意义(t= - 14.87,P＜0.01);PD组正性[(11.8±1.0)分]和中性[(7.9±1.4)分]情绪效价图片再认成绩与对照组[正性(12.4±2.2)分,中性(8.2±1.3)分]比,差异均无统计学意义。结论 早期未治疗PD患者负性效价情绪记忆存在损害,而正性和中性效价情绪记忆相对保留。     

精神分裂症患者情绪记忆损害的研究

目的 探讨精神分裂症患者的情绪记忆及其与精神症状的相关性.方法 采用情绪图片的同忆和再认测试评定40例精神分裂症患者与40名止常对照的情绪记忆,同时采用阳性与阴性症状量表(PANSS)评定患者临床症状.结果 两组间图片评分测试结束10 min后和72 h后对负性和中性图片的回忆率以及负性和止性图片的再认正确率差异均有统计学意义(P＜0.05).PANSS量衷阴性症状评分与负性和正性图片再认正确率呈负相关(r=-0.91,P＜0.01;r=-0.38,P＜0.05).患者组病程与10 min后负性图片回忆率(r=-0.33,P＜0.05)、72h后负性和正性图片回忆率(r=-0.36,P＜0.05;r=-0.36,P＜0.05)、负性图片再认正确率(r=-0.34,P＜0.05)呈负相关.结论 精神分裂症患者存在情绪记忆损害,且与精神症状相关.     

阿尔茨海默病的前瞻性记忆损害

目的 探讨阿尔茨海默病（Alzheimer's disease,AD）患者前瞻性记忆(prospective memory,PM)改变的特征,初步了解基于事件的前瞻性记忆(EBPM)和基于时间的前瞻性记忆( TBPM)在早期AD患者中的损害情况。方法 建立前瞻性记忆的神经心理学测验方法,测试20例AD患者（AD组）以及年龄、教育程度相匹配的20例遗忘型轻度认知损害（amnesia mild cognitive impairment,aMCI）患者（aMCI组）及30名健康人（NC组）。结果 与NC组及aMCI组前瞻性记忆(2.23 +0.77、4.83+1.09,1.00+1.03、3.10±1.52)及情景记忆成绩(0.70±0.12、0.66 +0.16,0.45±0.07、0.54±0.10)相比,AD组的成绩(0.20±0.41、2.05±1.43,0.33±0.12、0.32±0.10)差异均有统计学意义,而EBPM的成绩差异更明显（t=-2.792,P＜0.01;t=-10.761,P＜0.01）。结论 早期AD患者的记忆障碍不仅表现为情景记忆的损害,前瞻性记忆损害可能更为突出,且AD的前瞻性记忆损害与aMCI患者呈现了一致性,提示前瞻性记忆的早期测查可能会有利于AD的早期诊断。     

原发性失眠患者程序性记忆改变

目的 探讨原发性失眠(primary insomnia,PI)患者的程序性记忆是否损害及其特征.方法 采用类别产生和运动序列任务对36例PI患者及36名对照进行程序性记忆检测,同时用自由词任务检测其陈述性记忆.结果 PI患者的类别产生[7.0(6.0,8.8)与9.0(9.0,11.0),Z=5.537,P＜0.01]、运动序列[8.0±3.3与11.5 (8.6,13.8),Z=4.152,P＜0.01]和自由词任务的即刻回忆[3.0(2.3,4.0)与6.0(5.0,7.0),Z=6.479,P＜0.01]、延时回忆[9.0士2.2与11.0(10.0,12.0),Z=4.747,P＜0.01]和延时再认[15.0 (13.0,15.0)与15.0(15.0,15.0),Z=4.637,P＜0.01]的正确数均明显少于对照组.按失眠类型分层显示早醒组的运动序列、延时回忆与延时再认正确数均明显低于入睡难和睡眠维持难组.结论 PI患者程序性记忆和陈述性记忆均受损,早醒组的记忆损害可能更严重.     

早期帕金森病患者项目记忆及源记忆能力的研究

目的研究早期帕金森病(PD)患者项目记忆及源记忆的特点。方法对25例早期PD患者(PD组)及25名健康对照者(正常对照组)进行MMSE、词汇流畅性测试(VFT)、数字广度(DS)、stroop色词试验、听觉词汇学习测试(AVLT)以及项目记忆、源记忆检查,并进行比较。结果 PD组和正常对照组MMSE、VFT、DS、stroop色词试验差异无统计学意义(均P0.05)。与正常对照组比较,PD组AVLT即刻回忆评分显著降低(P0.05),延迟回忆评分差异无统计学意义(P0.05)。与正常对照组比较,PD组源记忆正确度显著降低(t=-2.800,P0.05),记忆区别度差异无统计学意义(t=-1.462,P0.05)。结论早期PD患者的情景记忆障碍主要表现为源记忆障碍,项目记忆却相对保留,可能与其额叶功能损害有关。     

帕金森病患者记忆扫视的特点

目的 研究帕金森病(PD)患者记忆扫视的特点,探讨记忆扫视对PD辅助诊断的价值.方法 选取53例早、中期PD患者作为PD组,同时选取36名年龄匹配的健康受试者作为对照组.对所有受试者进行记忆扫视检查和事件相关电位P300检查,并对检查结果进行比较;同时,对29例早期PD亚组患者的记忆扫视结果进行单独分析.结果 与健康受试者相比,PD组患者记忆扫视速度、初始增益明显降低,记忆扫视潜伏期明显延长,多余扫视和多阶模式扫视的发生率明显增多(U=124.000、37.000;均P＜0.0l),这些异常在早期PD患者亚组中已经非常明显;PD患者事件相关电位P300潜伏期[( 384.76±34.48) ms]较健康受试者[(352.42±24.99) ms]延长(t=-4.791,P＜0.01);多阶模式扫视的发生率对区分PD患者和健康受试者具有很好的敏感度(96.2％)和特异度(94.4％).结论 PD患者记忆扫视各项指标检查结果明显异常,可能是PD患者脑干扫视通路和额叶功能损害的反映.记忆扫视检查在PD的辅助诊断方面可能具有一定的应用价值.     

不同年龄正常人群记忆错误的比较

目的探讨不同年龄正常人群记忆错误(FM)的特征。方法对青年组(20～30岁)、中年组(40～50岁)及老年组(65～85岁)各30名健康人在神经心理学背景测试[包括简明精神状态检查(MMSE)量表、词汇流畅性测试(VFT)、数字广度(DS)、画钟测试(CDT)、Rey-听觉词汇学习测试(AVLT)]的基础上,进行图片诱发情景记忆错误试验。结果 (1)神经心理学背景测试结果:与青年组和中年组比较,老年组MMSE、DS顺背、CDT、AVLT即刻和延迟回忆得分明显降低(均P<0.05);青年组、中年组和老年组在DS倒背、AVLT的延迟再认得分依次明显递减(均P<0.05);(2)图片诱发情景记忆错误试验结果:与青年组和中年组比较,老年组卡片回忆率[(68±17)%]、故事成份回忆率[(77±14)%]、正确再认率[(73±12)%]明显降低(均P<0.05);记忆错误率[(24±13)%]、记忆错误发生率[(25±7)%]均明显高于中年组[(14±6)%、(15±4)%],中年组明显高于青年组[(8±7)%、(9±6)%](均P<0.05)。结论随着年龄的增长情景记忆下降,情景记忆错误增加,可能是导致老年人主观抱怨增加的主要原因。     

帕金森病患者情绪与情绪词注意偏向相关分析

目的探讨慢性帕金森病(Parkinson's Disease,PD)患者情绪与注意偏向相关性。方法将80例PD患者及80例健康对照者(health controls,HC)作为研究对象;所有被试的情绪状况水平采用焦虑症状自评量表(Self-Rating Anxiety Scale,SAS)和抑郁症状自评量表(Self-rating depression scale,SDS)进行评估;注意偏向评估采用中文情绪词stroop测试进行评估。结果 PD组在SDS得分方面高于HC组,差异有统计学意义[(50.60±10.30)分vs(44.11±12.14)分,t=-3.645,P0.001];PD组在负性词的反应时高于HC组,差异有统计学意义[分别为(1698.71±199.86)ms,(1625.95±241.64)ms;t=-2.076,P=0.040];PD患者对负性词反应时与SDS量表得分呈正相关(r=0.241,P=0.031)。结论 PD患者存在情绪和对注意偏向方面的异常,抑郁情况与对负性词的注意偏向密切相关。     

认知矫正治疗前后慢性精神分裂症患者功能磁共振成像的对照研究

目的 探讨认知矫正治疗对精神分裂症患者工作记忆相关脑区活动的影响.方法 对10例病情稳定的慢性精神分裂症患者进行为期6个月的认知矫正治疗,分别于治疗前后进行韦克斯勒记忆量表(WMS)测查及功能磁共振成像(fMRI)测量.结果 (1)WMS测查:治疗后再认[(8.11±4.34)分]和再生[(10.22±3.35)分]以及Benton错误[(3.75±2.92)分]均较治疗前[分别为(5.78±2.95)分、(8.56±3.21)分和(8.00±6.28)分]改善,均P＜0.05.(2)fMRI:治疗前后的反应时和正确率比较,差异无统计学意义(P＞0.05).治疗后在高负荷条件下,背侧前额叶皮质(DLPFC)区域(Brodmann46区)的激活范围(x,y,z=-51,36,15;k=40,t=7.21)小于治疗前的激活范围(x,y,z=-48,24,24,k=154,t=12.72),治疗前后DLPFC区域激活(x,y,z=-24,36,18,k=12,t=3.75)的差异有统计学意义(P＜0.005);在低负荷条件下,治疗前后DLPFC区域激活的差异无统计学意义(P＞0.05).结论 认知矫正治疗能改善精神分裂症患者工作记忆相关脑区的活动.     

Alzheimer's disease and feeling-of-knowing in episodic memory

Episodic memory feeling-of-knowing (FOK) was examined in 16 patients with Alzheimer’s disease (AD), 16 elderly participants, and 16 younger adults. Participants were given cued recall and recognition tests of 20 critical cue-target words. Subsequently, they judged their FOK for non-recalled words in terms of how likely they thought they would be to recognize the keywords on a subsequent recognition test. The results indicated dementia-related deficits on both the recall and recognition tests. Compared to older adults, AD patients exhibited impaired FOK accuracy. This pattern of outcome indicates that early AD is associated with a deficit in episodic memory and a deficit in memory monitoring for newly learned information. Furthermore, our observation revealed that in AD, episodic memory may be a more important factor than executive function in explaining the FOK inaccuracy.     

A role for right medial prefontal cortex in accurate feeling-of-knowing judgements: evidence from patients with lesions to frontal cortex

The hypothesis that prefrontal cortex plays a critical role in accurate predictions of episodic memory performance was tested using the feeling-of-knowing (FOK) paradigm. Fourteen patients with a broad spectrum of damage to the frontal cortex and matched controls read sentences and later were tested for recall memory, confidence judgments, and FOK accuracy using as cues the sentences with the final word missing. While frontal patients were impaired at recall and recognition memory, they were able to make accurate confidence judgments about their recall attempts. By contrast, as a group, the patients were markedly impaired in the accuracy of their prospective FOK judgments. Lesion analysis of frontal patients with clear FOK impairment revealed an overlapping region of damage in right medial prefrontal cortex. These findings provide functional and anatomical evidence for a dissociation between recall confidence and prospective memory monitoring and are discussed in terms of familiarity and access theories of FOK predictions.     

早中期帕金森病患者前瞻性记忆损害的特点

目的 探讨早中期帕金森病(PD)患者前瞻性记忆损害的特点.方法 采用安徽医科大学前瞻性记忆检查方法,对15例早中期PD患者和15名健康对照者进行基于事件的前瞻性记忆(EBPM)和基于时间的前瞻性记忆(TBPM)检查.结果 PD组EBPM的检查成绩明显低于对照组,二者分别为(3.93±2.69)分和(6.00±2.17)分,差异有统计学意义(t=-2.318,P<0.05);PD组与对照组TBPM的检查成绩分别为(3.47±1.96)分和(3.80 ±1.70)分,差异无统计学意义(t=-0.498,P>0.05).结论 早中期PD患者存在EBPM损害,而TBPM相对保留.     

Metamemory monitoring in mild cognitive impairment: Evidence of a less accurate episodic feeling-of-knowing

This study aimed at exploring metamemory and specifically the accuracy of memory monitoring in mild cognitive impairment (MCI) using an episodic memory feeling-of-knowing (FOK) procedure. To this end, 20 people with MCI and 20 matched control participants were compared on the episodic FOK task. Results showed that the MCI group made less accurate FOK predictions than the control group by overestimating their memory performance on a recognition task. The MCI overestimation behavior was found to be critically related to the severity of their cognitive decline. In the light of recent neuroanatomical models showing the involvement of a temporal-frontal network underlying accurate FOK predictions, the role of memory and executive processes was evaluated. Thus, participants were also administered memory and executive neuropsychological tests. Correlation analysis revealed a between-group differential pattern indicating that FOK accuracy was primarily related to memory abilities in people with MCI, whereas it was specifically related to executive functioning in control participants. The lesser ability of people with MCI to assess their memory status accurately on an episodic FOK task is discussed in relation to both their subjective memory complaints and to their actual memory deficits which might be mediated by the brain vulnerability of their hippocampus and medial temporal system. It is suggested that their memory weakness may lead people with MCI to use other less reliable forms of memory monitoring.     

早期未治疗帕金森病患者前瞻性记忆损害和事件相关电位改变的特点

目的 探讨早期未治疗PD患者前瞻性记忆损害情况和事件相关电位(ERPs)改变的特点.方法 选择自2007年1月至2010年10月在河南省人民医院神经内科门诊确诊的早期未治疗的PD患者33例(PD组)和同期该家医院31名健康体检者(健康对照组)进行研究,研究项目包括基于事件的前瞻性记忆(EBPM)、基于时间的前瞻性记忆(TBPM)和ERPs综合检查.结果 PD组EBPM和TBPM评分均明显低于对照组,差异均有统计学意义(P＜ 0.05); PD组N2、P300潜伏期均较健康对照组明显延长,P300波幅与对照组比较明显降低,差异均有统计学意义(P＜0.05).相关分析结果显示,PD患者的P300潜伏期与EBPM和TBPM均呈明显正相关,r值分别为0.628、0.582,P值均为0.000.结论 早期未治疗PD患者存在EBPM和TBPM损害；P300潜伏期可作为判定PD患者EBPM和TBPM损害程度的电生理指标.     

Event-based prospective memory in newly diagnosed, drug-naive Parkinson's disease patients

The present study investigated memory for intention in individuals with Parkinson's disease (PD) who were newly diagnosed and not yet treated to avoid the effect of therapy as a potential confounding variable. A comprehensive neuropsychological battery and an event-based prospective memory task were administered to 41 subjects with de novo PD and 40 control subjects. Separate scores were computed for correct execution of intended action (prospective component) and recall of intention (retrospective component). PD patients performed marginally worse (p = .053) than controls on the prospective component of the task. On the other hand, the performance of the two groups was comparable for the retrospective component. Neuropsychological findings revealed lower performance of the PD group in episodic memory and in some measures of executive functions. These results suggested a subtle prospective memory dysfunction present at the initial stage of PD, which may be related to disruption of fronto-striatal circuitry.