【摘要】：目的本研究主要通過對小腦半球及蚓部病變患者進行神經(jīng)心理及情感測評,并結合頭顱MRI探討小腦不同部位的認知作用,探索小腦與認知間更深層次的聯(lián)系,為今后針對小腦病變的診治、康復和預后提供相關依據(jù)。 方法以2013年3月至2014年3月我院神經(jīng)內(nèi)科及神經(jīng)外科收治的不同部位小腦病變(小腦梗死、小腦出血、小腦占位性病變)患者21例作為病例組；同時隨機選取臨床及影像學檢查無任何神經(jīng)系統(tǒng)異常者21例作為對照組。病例組在發(fā)病后10-30天內(nèi)病情穩(wěn)定,能完成所有認知功能測驗。病例組和對照組均采用蒙特利爾認知評估量表(MoCA)進行認知的總體評估；Rey聽覺詞匯學習測試(AVLT)、數(shù)字記憶廣度測試(DST)、臨床記憶量表(CMS)進行記憶功能評估；符號-數(shù)字模式測驗(SDMT)、線段等分測驗(TLBT)、連線測試(TMT)進行視空間功能評估；威斯康星卡片分類測試(WCST)進行執(zhí)行功能評估；漢語失語癥檢查量表(CAES)進行語言功能評估；漢密爾頓抑郁量表(HAMD)、神經(jīng)精神問卷(NPI)進行情緒認知評估。應用3.0T核磁共振掃描系統(tǒng)對小腦左右側半球病變患者行全腦磁共振成像,使用軟件MRIcron在標準層模板上將所有邊緣清晰的T1成像病灶進行重疊。采用SPSS17.0軟件對數(shù)據(jù)進行統(tǒng)計分析。 結果(1)小腦病例組與對照組比較,病例組MOCA、AVLT、DST、指向記憶、聯(lián)想學習、圖像自由回憶、無意義圖形再認、人物特點回憶、總記憶商、SDMT、TLBT、 CC、RCP、RFP、語言理解、命名得分均顯著低于對照組,TMT、RE、RP、nRPE、HAMD、NPI得分均顯著高于對照組(P0.01,P0.05)。(2)小腦病例組中,左側半球病變、右側半球病變及蚓部病變?nèi)M比較,左側半球病變組聯(lián)想學習得分高于右側半球病變組(P0.05)；左側半球病變組TLBT、RCP、RFP得分均顯著低于右側半球病變組及蚓部病變組,RF得分顯著高于右側半球病變組及蚓部病變組(P0.01,P0.05)；右側半球病變組RP、nRPE得分均顯著高于左側半球病變組及蚓部病變組,語言理解、命名得分均顯著低于左側半球病變組及蚓部病變組(P0.01,P0.05)；蚓部病變組HAMD、NPI得分均顯著高于左側半球病變組及右側半球病變組(P0.01)。 結論(1)小腦參與了部分認知的形成過程,小腦病變后不同認知功能—記憶、視空間、執(zhí)行功能、語言功能、情緒認知均有不同程度的下降。(2)小腦單側或蚓部病變均使記憶、視空間、執(zhí)行功能、語言功能、情緒認知產(chǎn)生不同程度的受損。(3)小腦不同部位病變后認知損害存在差異—左側小腦半球病變后視空間、抽象概括能力、概念形成能力受損嚴重；右側小腦半球病變后注意力、認知轉移能力受損嚴重；小腦蚓部病變后情緒認知受損嚴重。(4)在右利手患者中,右側小腦半球病變后語言功能受損嚴重。
[Abstract]:Objective to explore the deeper relationship between cerebellum and cognition by measuring neuropsychology and emotion in patients with cerebellar hemisphere and vermis lesions, and exploring the cognitive function of different parts of cerebellum with MRI. To provide relevant evidence for the diagnosis, treatment, rehabilitation and prognosis of cerebellar lesions in the future. Methods from March 2013 to March 2014, 21 patients with cerebellar lesions (cerebellar infarction, cerebellar hemorrhage, cerebellar space occupying lesion) were treated in neurology and neurosurgery department of our hospital. At the same time, 21 cases with no abnormal nervous system were randomly selected as control group. The patient group was stable within 10-30 days and could complete all cognitive function tests. Both the case group and the control group were assessed with the Montreal Cognitive Assessment scale (MoCA) for the overall assessment of cognition. (AVLT), (AVLT), digital memory span test (DST), clinical memory scale (CMS) were used to evaluate the memory function. (SDMT), line segment equipartition test (TLBT), connection test (TMT) for visual spatial function evaluation Wisconsin card sorting test (WCST) for executive function evaluation Chinese aphasia scale (CAES) for language function evaluation; Hamilton Depression scale (HAMD),) Neuropsychiatric questionnaire (NPI) was used to assess emotion cognition. The left and right hemisphere lesions of the cerebellum were studied by using 3.0T MRI system. All T1 lesions with clear edge were overlapped on the standard layer template by software MRIcron. The data were analyzed by SPSS17.0 software. Results (1) compared with the control group, the cerebellar case group showed that MOCA,AVLT,DST, directed memory, associative learning, image free recall, meaningless pattern recognition, character feature recall, total memory quotient SDMTT TLBT, CC,RCP,RFP, language comprehension. The nomenclature scores were significantly lower than those in the control group (P 0.01). (2), and the scores of the left hemisphere lesion, the right hemisphere lesion and the vermis lesion were significantly higher than those in the control group. The scores of association learning in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group (P0.05), and the TLBT,RCP,RFP scores in the left hemisphere lesion group were significantly lower than those in the right hemisphere lesion group and the vermis lesion group (P 0.05), and the RF scores in the left hemisphere lesion group were significantly higher than those in the right hemisphere lesion group and the right hemisphere lesion group (P 0.05). The RP,nRPE scores in the right hemisphere lesion group were significantly higher than those in the left hemisphere lesion group and the vermis lesion group. The language understanding and naming scores were significantly lower in the right hemisphere lesion group than in the left hemisphere lesion group and the vermis lesion group (P 0.05). The HAMD,NPI scores in the vermis lesion group were significantly higher than those in the left hemisphere lesion group and the right hemisphere lesion group (P0.01). Conclusion (1) the cerebellum is involved in the formation of partial cognition, and different cognitive functions, such as memory, visual space, executive function, language function and emotional cognition, are decreased in different degree after cerebellar lesion. Visual space, executive function, language function and emotional cognition are impaired to different degrees. (3) there are differences in cognitive impairment in different parts of cerebellum-posterior space of left cerebellar hemispheres, abstract generalization ability and impaired ability of concept formation; In the right cerebellar hemisphere, the ability of cognitive transfer was seriously impaired, and the emotional cognition was seriously impaired after the lesion of cerebellar vermis. (4) in the patients with right-handed hand, the speech function of the right cerebellar hemisphere was seriously impaired after the lesion of the right cerebellar hemisphere.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R741

【共引文獻】

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