ObjectivesTo explore the characteristics of cognitive deficits of Benign epilepsy of childhood with centrotemporal spikes (BECTS).MethodsA total of 61 BECTS patients who visited Neurology Clinic of Xuanwu Hospital Capital Medical University between September 2010 to December 2019 and 60 healthy controls were enrolled in our study. All patients and healthy controls performed a series of neuropsychological tests to assess their cognitive function in the "Multi-dimensional psychology" of Beijing Normal University, including attention; memory; arithmetic calculation; language processing; executive function; visuospatial processing; visual perception; psychomotor speed. Lastly, independent sample t-test and friedman test were performed on the scores of BECTS group and controls using SPSS 20.0 and we conducted a multi-factor comprehensive analysis of correlation between clinical criteria and cognitive dysfunction in BECTS.ResultsCompared with 60 healthy controls, the as group got an average score of 19.56±2.91 in Paired Association Learning Test (P<0.001), (23.67±9.50) in Word Discrimination Test (P=0.017), (61.45±13.14) in Object Quantity Perception Task (P=0.040), (6.54±1.47) in Digit Span Test (P<0.001), (5.79±5.90) in Vocal Perception Test (P<0.001), (35.10±2.33) in Taylor Complex Figure Test (P<0.001) and (700.34±493.053) (P=0.008) in Choice Reaction Time Test. The results of these tests are inferior to the control group and the remaining 10 tests are of no statistical significance. There were 36 children with onset of seizure before 8 years of age. Compared with the patients experienced onset of illness at a later age, the 36 patients exhibited lower scores in most of the neuropsychological tests including Visual Tracking Task, Spatial Memory Task, Simple Subtraction Task, Number Comparison Test, Language Rhyme Test, Word Discrimination Testand Visual Perception Task (P<0.05). 34 patients received monotherapy, and 27 received a combination of 2 or 3 anti-epileptic drugs. The scores of attention, memory, visual perception and reaction tests in the multi drug treatment group were lower than those in the single drug treatment group (P<0.05).ConclusionsChildren with BECTS have impairment in attention, vocal perception, visual perception, memory and psychomotor speed. The younger the age of onset, the more severe the cognitive impairments. The degree of cognitive deficitsinchildren treated with multi drugs was more serious than that of children treated with single drugs.
Aphasia is one of the common disabling lesions and sequelae in stroke patients. In post-stroke aphasia patients, impairments of non-verbal cognitive domain often occur, which seriously affect daily social contact and quality of life. Cognitive neuropsychological rehabilitation is a neuropsychological rehabilitation based on the development of cognitive neuropsychological theory. It is currently applied in the field of rehabilitation of brain cognitive function, opening up a new way for evaluation and treatment of post-stroke aphasia. This paper introduces the general features of the application of cognitive neuropsychological rehabilitation, expounds the evaluation model and treatment principles of cognitive neuropsychological rehabilitation, and discusses its application in the evaluation and treatment of post-stroke aphasia, so as to provide ideas for the linguistic and non-linguistic cognitive rehabilitation of post-stroke aphasia.
Objective To investigate the effect of continuous positive airway pressure (CPAP) on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease (AD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group (20 cases) and a simple medicine treatment group (22 cases). The changes of neurocognitive function were assessed by Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE) and Hopkins Verbal Learning Test-revised (HVLT). Patient Health Questionnaire-9 (PHQ9) was used to evaluate the depression mood changes. The sleep characteristics and respiratory parameters were evaluated by polysomnography. The changes of the patients’ sleep status were assessed by Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The changes of sleep status, cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment, and with the simple medicine treatment group. Results After three months of CPAP treatment, the ESS, PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment, whereas MoCA, MMSE and HVLT (total scores and recall ) in the CPAP combined treatment group were increased compared with those before treatment (P<0.05). After CPAP treatment, the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment (P<0.05), and the minimum blood oxygen saturation was significantly higher than that before treatment (P<0.05). However, the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment (P>0.05). The ESS, PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group (P<0.05), while there was no statistically significant changes of cognitive scores between the two groups (P>0.05). Conclusions The degree of low ventilation and hypoxia is alleviated, and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment. Cognitive function is significantly improved, whereas there is no significant change in sleep structure disorder.
ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.
【摘要】 目的 通过比较遗忘型轻度认知障碍（amnestic mild cognitive impairment，aMCI）和血管性认知障碍非痴呆型（vascular cognitive impairment-no dementia，VCI-ND）患者及正常老年人群在简易智能精神状态检查量表（mini mental state examination，MMSE）、听觉词语学习测验（auditory verbal learning test，AVLT）、画钟试验（clock drawing test，CDT）及临床痴呆评定量表（clinical dementia rating scales，CDR）中的表现，进一步分析aMCI和VCI-ND在认知损害方面的不同特点。 方法 选取首都医科大学宣武医院神经内科门诊收治aMCI患者23例及VCI-ND患者27例（CDR＝0.5分），同时选取40名正常老年人（CDR=0分）作为对照组。每位受试者均进行MMSE、AVLT、CDT及CDR等神经心理学量表测查，分析以上3组被试各项神经心理学测查得分之间的差异。 结果 各组受试者的年龄、性别及受教育程度差异无统计学意义（Pgt;0.05），具有可比性。aMCI和VCI-ND组在MMSE、CDT、即刻记忆、延迟记忆及延迟再认检测中的平均值均低于对照组，且差异均具有统计学意义（Plt;0.05）。aMCI和VCI-ND两组除延迟再认检测外，其余各项测查的平均分均无统计学意义（Pgt;0.05）。在延迟再认检测中，aMCI组（6.65±4.00）较VCI-ND组（8.67±2.76）再认词语数量少，两组延迟再认的得分均低于对照组（12.83±1.77），差异有统计学意义（Plt;0.05）。 结论 aMCI和VCI-ND在记忆力、执行能力和信息处理能力方面较正常老年人均有所损害。由于aMCI和VCI-ND不同的病理改变，导致患者存在不同类型的记忆储存和提取机制。【Abstract】 Objective To investigate the different patterns of cognitive impairment in patients with amnestic mild cognitive impairment (amci), vascular cognitive impairment-no dementia (VCI-ND) and normal elder people. Methods A total of 23 patients with aMCI and 27 patients with VCI-ND (CDR＝0.5) and another 40 healthy elder people (CDR=0) were selected. Each individual underwent the neuropsychological tests, including mini mental state examination (MMSE), auditory verbal learning test (AVLT), clock drawing test (CDT), clinical dementia rating scales (CDR) and hamilton rating scale for depression (HAMD). The differences between the three groups were analyzed. Results The differences in age, sexes, and the education background among the three groups were not significant (Pgt;0.05) which meant comparability. The mean scores of MMSE, CDT, instant memory and delayed awareness in aMCI and VIC-ND group were much lower than that in the control group (Plt;0.05). The differences in all the test items except for delayed awareness between aMCI group and VCI-ND groups were not significant (Pgt;0.05). However, in the recall recognition test, these three groups had significant differences: the score in patients with aMCI (6.65±4.00) was much lower than that in patients with VCI-ND (8.67±2.76; Plt;0.05), and the scores of the two groups were both lower than that in the normal aging group (12.83±1.77; Plt;0.05). Conclusion Compared with normal elder people, the cognition of aMCI and VCI-ND patients is impaired severely. The memory tests suggeste that compared with aMCI patients, VCI-ND patients may have different neuropathological changes leading to different mechanism of memory encoding and retrieval.
ObjectiveTo analyze of the extent of neuropsychological damage in post-traumatic epilepsy patients. MethodsOne hundred and thirty-five patients treated at the Department of Neurosurgery, the 904th Hospital of PLA from January 2016 to December 2018 were analyzed retrospectively, including 94 males and 41 females, with an average age of (32.94 ± 9.51) years. They were divided into 3 groups: 40 patients with post-traumatic epilepsy (epilepsy group): 53 trauma patients without post-traumatic epilepsy (trauma group) and 42 patients with health examination (control group). Neuropsychological assessment using the following scales: Mini-mental State Examination (MMSE): Montreal Cognitive Assessment-Basic (MoCA-B): Audio Verbal Memory Test (AVMT): Rey-Osterrieth Complex Figure Test (CFT): Trail Making Test (TMT): Hamilton Depression Scale (HAMD): Activity of Daily Living (ADL). ResultsThe results of one-way ANOVA showed that there was significant difference between all scales of epilepsy group, trauma group and control group (P<0.01). MMSE and MoCA-B scores: Compared with trauma group, epilepsy group decreased significantly, but there was no significant difference between groups (P>0.05); Memory and spatial structure ability: AVMT short/long delayed memory, CFT recall and copy test results showed that epilepsy group decreased more significantly than trauma group, and there was statistical significance between groups (P<0.05); Executive ability: TMT-A and TMT-B showed that epilepsy group spent longer time than trauma group, and there was significant difference between groups (P<0.01); Depressive symptoms: HAMD scale showed significant difference between epilepsy group and trauma group (P<0.01): while there was no statistical difference between trauma group and control group (P>0.05); Activity of daily living: ADL scale results showed that there was no significant difference between epilepsy group and trauma group (P>0.05). ConclusionPost-traumatic epilepsy can aggravate the cognitive impairment of patients, mainly in the decline of memory, spatial structure and executive ability, and prone to depressive symptoms. At the same time of treating epilepsy seizures, patients with post-traumatic epilepsy should be screened and assessed early in neuropsychology to improve their quality of life and return to society as soon as possible.
ObjectiveThrough neuropsychological assessment, explore the factors that may cause cognitive impairment in patients with focal epilepsy.MethodsCollected 53 epilepsy patients in outpatients and inpatients of Tianjin Medical University General Hospital from March 2016 to January 2020, including 25 males and 28 females, with an average age of (23.58±13.24) years old, and the course of disease (6.49±7.39), all met the 2017 ILEA diagnostic criteria for focal epilepsy, and there was no history of progressive brain disease or brain surgery. Carry out relevant cognitive assessments for the enrolled patients, use SPSS statistical software to conduct Spearman correlation analysis on the cognitive functions of the study subjects, and further analyze the related factors of cognition through Logistic regression analysis to clarify the factors related to cognition whether it may be a risk factor for cognitive impairment in patients with focal epilepsy.Results Spearman correlation analysis showed that the FIQ of patients with focal epilepsy was related to education level, age of onset, seizure pattern, total number of seizures, AEDs and EEG interval discharge side (P<0.05). Binary Logistic regression analysis shows that among all cognitive-related factors, only the number of AEDs (P=0.003) and EEG interval discharge (P=0.013) are the risk of cognitive impairment in patients with focal epilepsy factor.ConclusionIn the clinical treatment of epilepsy, seizures should be actively controlled, but the types of drugs should be minimized. When there are more than 3 kinds of drugs, surgical treatment or other non-surgical treatments can be considered. At the same time, the EEG should be reviewed regularly to understand the changes in epileptiform discharges between episodes.