【摘要】：第一部分青少年肌陣攣性癲癇患者的認(rèn)知功能研究目的：研究新診斷青少年肌陣攣性癲癇(juvenile myoclonic epilepsy,JME)患者的認(rèn)知功能,探討影響其認(rèn)知功能的主要因素。方法：對(duì)納入研究的JME患者進(jìn)行連線測驗(yàn)、Stroop測驗(yàn)、詞匯流暢性測驗(yàn)、聽覺詞匯回憶測驗(yàn)以及數(shù)字廣度測驗(yàn)等神經(jīng)心理學(xué)測試；使用焦慮和抑郁自評(píng)量表、以及簡易智力狀態(tài)量表等分別對(duì)JME患者進(jìn)行情緒及智能測驗(yàn)。對(duì)比研究63例新診斷JME患者和63例健康自愿者的認(rèn)知功能,與此同時(shí),對(duì)于影響認(rèn)知功能的可能因素如患者的年齡、性別、文化程度、有無家族史、腦電圖情況及癲癇的病程、發(fā)病的年齡以及發(fā)作頻率等也進(jìn)行相關(guān)的分析。結(jié)果：與對(duì)照組相比,病例組患者在連線測驗(yàn)中的A型連線時(shí)間(P0.01)和B型連線時(shí)間(P0.01),Stroop字色干擾測驗(yàn)上的卡片A和卡片B的耗時(shí)數(shù),卡片B和卡片C的正確數(shù)(p0.01),詞匯流暢性測驗(yàn)的詞匯總數(shù)(P0.01),聽覺詞匯回憶測驗(yàn)中的短時(shí)延遲回憶、長時(shí)延遲回憶以及再認(rèn)回憶(P0.01),數(shù)字廣度測驗(yàn)的順背數(shù)及倒背數(shù)(p0.01)上差異有統(tǒng)計(jì)學(xué)意義；而在智力測驗(yàn)和情緒測驗(yàn)的結(jié)果上,病例組與對(duì)照組相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。通過對(duì)認(rèn)知功能的危險(xiǎn)因素進(jìn)行相關(guān)分析,表明患者發(fā)病的年齡與詞匯的記憶存在密切的關(guān)系(r=0.443,p0.05),而在注意力和執(zhí)行能力上,兩者無明顯的差異。結(jié)論：新診斷的青少年肌陣攣性癲癇患者在注意力、記憶力以及額葉的認(rèn)知功能方面可能存在著不同程度的障礙。第二部分 兒童失神癲癇患者認(rèn)知功能研究目的：測試兒童失神癲癇的認(rèn)知功能狀態(tài)(children with absence epilepsy, CAE)。方法：對(duì)納入研究的CAE患者進(jìn)行連線測驗(yàn)、Stroop測驗(yàn)、詞匯流暢性測驗(yàn)、聽覺詞匯回憶測驗(yàn)以及數(shù)字廣度測驗(yàn)等神經(jīng)心理學(xué)測試；使用焦慮和抑郁自評(píng)量表、以及簡易智力狀態(tài)量表等分別對(duì)CAE患者進(jìn)行情緒及智能測驗(yàn)。對(duì)比研究25例新診斷CAE患者和25例健康自愿者的認(rèn)知功能,結(jié)果：與對(duì)照組相比,病例組患者在連線測驗(yàn)中的A型連線時(shí)間(P0.01)和B型連線時(shí)間(P0.01), Stroop字色干擾測驗(yàn)上的卡片A和卡片B的耗時(shí)數(shù),卡片B和卡片C的正確數(shù)(p0.01),詞匯流暢性測驗(yàn)的詞匯總數(shù)(P0.01),聽覺詞匯回憶測驗(yàn)中的短時(shí)延遲回憶、長時(shí)延遲回憶以及再認(rèn)回憶(P0.01),數(shù)字廣度測驗(yàn)的順背數(shù)及倒背數(shù)(p0.01),智力測驗(yàn)(P0.01)上差異有統(tǒng)計(jì)學(xué)意義；而在情緒測驗(yàn)的結(jié)果上,病例組與對(duì)照組相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：兒童失神癲癇患者存在一定程度認(rèn)知功能障礙,這種功能障礙趨向總的認(rèn)知水平,而非是某一方面認(rèn)知功能缺陷。第三部分新診斷青少年肌陣攣性癲癇患者的fMRI研究目的：運(yùn)用fMRI研究新診斷青少年肌陣攣性癲癇患者靜息態(tài)下的神經(jīng)網(wǎng)絡(luò),探討影響其認(rèn)知功能損傷的病理生理機(jī)制。方法：對(duì)納入研究的23例JME患者及23例健康對(duì)照組進(jìn)行全腦rs-fMRI數(shù)據(jù)采集,采用fALFF法分析JME患者及健康對(duì)照組靜息態(tài)下腦功能活動(dòng)特點(diǎn),并構(gòu)建腦功能網(wǎng)絡(luò)分析JME患者的腦網(wǎng)絡(luò)異常；同時(shí)采集JME患者及健康對(duì)照組的全腦3D TIWI圖像,采用基于曲面的皮層形態(tài)學(xué)方法,觀察JME患者及健康對(duì)照組皮層厚度的差異。結(jié)果：與健康對(duì)照組相比較,JME患者fALFF減低的區(qū)域主要分布于左側(cè)內(nèi)側(cè)額上回、右側(cè)頂下小葉腦區(qū),fALFF增高的區(qū)域主要分布于右側(cè)梭狀回、左側(cè)中央前回、左側(cè)中央后回。ReHo值增加的腦區(qū)為左側(cè)顳下回、右側(cè)中央前回,ReHo值降低的腦區(qū)為左側(cè)前扣帶回、左側(cè)額葉中部。左眶額部Hub節(jié)點(diǎn)消失。皮層厚度減少的區(qū)域位于右角回、右顳中回及右顳下回。差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論：青少年肌陣攣性癲癇患者靜息態(tài)下神經(jīng)網(wǎng)絡(luò)存在異常,而神經(jīng)網(wǎng)絡(luò)的異常導(dǎo)致了患者在記憶力、注意力和執(zhí)行能力上的障礙。
[Abstract]:Part 1 cognitive function study in the patients with juvenile myoclonic epilepsy: To study the cognitive function of the newly diagnosed juvenile myoclonic epilepsy (JME) patients and to explore the main factors affecting their cognitive function. Methods: a connection test, a Stroop test, and a fluency of vocabulary were conducted for the JME patients enrolled in the study. The neuropsychological tests, such as test, auditory vocabulary recall test and digital breadth test, were used to conduct emotional and intelligent tests on JME patients with anxiety and depression scale and simple mental state scale. The cognitive functions of 63 newly diagnosed JME patients and 63 healthy volunteers were compared and the effects of recognition on the cognitive function were compared. Possible factors such as patient's age, sex, education, family history, electroencephalogram and the course of epilepsy, age and frequency of seizures were also analyzed. Results: compared with the control group, the A connection time (P0.01) and B connection time (P0.01), Stroop word in the case group were compared with the control group. The time consuming number of card A and card B on the color interference test, the correct number of card B and card C (P0.01), the total number of vocabulary (P0.01) in the vocabulary fluency test, the short time delay memory in the auditory lexical recall test, the long time delayed recall and the recollection (P0.01), the number of breadth quizzes and the inverse number (P0.01) of the digital span test are statistically significant. The difference between the case group and the control group was not statistically significant (P0.05). The correlation analysis of the risk factors of cognitive function showed that there was a close relationship between the age of the patient and the memory of the vocabulary (r=0.443, P0.05), and there was no obvious difference between the two groups in attention and execution. Differences. Conclusions: the newly diagnosed juvenile myoclonic epilepsy may have different levels of impairment in attention, memory and cognitive function of the frontal lobe. The cognitive function of the second children with epileptic seizures is tested in the cognitive function of children with epilepsy (children with absence epilepsy, C Methods: (AE) methods: the CAE patients enrolled in the study were tested by the connection test, Stroop test, vocabulary fluency test, auditory vocabulary recall test, and digital breadth test, and other neuropsychological tests were performed on CAE patients with anxiety and depression scale, and simple mental state scale. 25 cases were compared and studied. Cognitive function of the newly diagnosed CAE patients and 25 healthy volunteers. Results: compared with the control group, the A type time (P0.01) and B connection time (P0.01) in the case group were in the connection test, the time time of the card A and card B on the Stroop color interference test, the correct number of card B and card C (P0.01), and the vocabulary of the vocabulary fluency test. The total number (P0.01), the short time delayed memory in the auditory lexical recall test, the long time delayed recall and the reminiscence recall (P0.01), the number of back numbers and the back number (P0.01) of the digital span test (P0.01), and the intelligence test (P0.01) were statistically significant, but there was no significant difference between the case group and the control group (P0.05). Conclusion: there is a certain degree of cognitive impairment in children with epileptic seizures. This dysfunction tends to a general cognitive level, not a cognitive impairment. The third part of the new diagnosis of juvenile myoclonic epilepsy: the use of fMRI to study the resting state of the newly diagnosed juvenile myoclonic epilepsy patients. The neuropathophysiological mechanism of the cognitive impairment was investigated by neural network. Methods: the whole brain rs-fMRI data were collected from 23 JME patients and 23 healthy controls. The brain functional activities of JME patients and healthy controls were analyzed by fALFF method, and the brain network of JME patients was constructed to analyze the brain network of the patients with the brain function network. At the same time, the whole brain 3D TIWI images of the JME patients and the healthy control group were collected, and the cortical thickness difference between the JME patients and the healthy control group was observed by the surface based cortical morphological method. Results: compared with the healthy control group, the region of the fALFF reduction in the JME patients was mainly distributed in the upper left medial frontal gyrus, the right parietal lobular region, fA The region of LFF increased mainly in the right fusiform gyrus, left anterior central gyrus, left posterior central gyrus and.ReHo value in the left temporal gyrus, right anterior central gyrus, and lower ReHo value in the left anterior cingulate gyrus, the left frontal lobe, and the left orbital frontal Hub node disappearing. The cortex thickness decreased in the right angle gyrus, right temporal gyrus and right The difference was statistically significant (P0.01). Conclusion: there is an abnormal neural network in the resting state of the juvenile myoclonic epilepsy, and the abnormal neural network causes the patient's impairment of memory, attention and executive ability.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.1

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5 苗茂華;太原市社區(qū)老年人認(rèn)知功能下降的影響因素研究[D];山西醫(yī)科大學(xué);2005年

6 吳燕t，

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