发作性头痛与慢性头痛患者神经心理学与注意功能影响的初步研究
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摘要
目的:探讨发作性头痛与慢性头痛患者注意功能影响的临床表现及其可能的作用机制。方法:通过纳入18例发作性头痛(episodic headache,EH)患者、20例慢性头痛(chronic headache,CH)患者和21例健康对照人群,分别进行神经心理学评估,包括简易精神状态评估量表(mini mental state exam,MMSE)、蒙特利尔认知评估量表中国北京版(Beijing Chinese version of Montreal Cognitive Assessment,Mo CA-C)、数字广度测试(digit span test,DS)、额叶功能评定量表(frontal assessment battery,FAB)、医院焦虑抑郁量表(hospital anxiety and depression subscales,HADS)和匹兹堡睡眠量表(Pittsburgh sleep quality index,PSQI)和注意力网络测试(attention networks test,ANT),并进行对比分析。结果:CH组的Mo CA-C(P值均<0.001)、DS(P=0.002或P=0.004)、HADS(焦虑:P<0.001或P=0.002;抑郁:P<0.001或P=0.001)、PSQI(P<0.001或P=0.001)评估结果均与健康对照组或EH组存在显著差异。CH组和健康对照组的FAB评估结果亦存在显著差异(P=0.021)。ANT测试结果显示3组间的警觉、定向效率和正确率无显著差异,但CH组的平均反应时间较健康对照组或EH组明显延长(P=0.002或P=0.035),执行控制效率较健康对照组明显降低(P=0.042)。结论:头痛损害注意功能,而CH组损害更明显,主要表现为CH患者执行注意力相关任务的平均反应时间延长、执行控制功能降低,提示CH损害了注意网络-执行功能,该功能的损害可能是头痛损害注意功能的关键机制之一。
Objective:To investigate the clinical features and possible mechanisms of attention function in patients with episodic headache and chronic headache. Methods:Through a total of 18 patients with Episodic Headache(EH),20 patients with chronic headache(CH)and 21 healthy controls,respectively,neuropsychological assessment including mini mental state assessment scale(mini mental state exam,MMSE),Montreal cognitive assessment(China-Beijing edition Beijing Chinese version of Montreal Cognitive Assessment,Mo CA-C),digital span test(digit span test,DS),frontal lobe function rating scale(frontal assessment battery,FAB),the hospital anxiety and Depression Scale(hospital Anxiety and depression subscales,HADS)and Pittsburgh Sleep Scale(Pittsburgh sleep quality index,PSQI)and attention network test(attention networks test,ANT),and comparative analysis. Results:There were significant differences in Mo CA-C(P< 0.001 or P< 0.001),DS(P=0.002 or P=0.004),HADS(anxiety:P< 0.001 or P=0.002;depression:P< 0.001 or P=0.001)and PSQI(P< 0.001 or P=0.001)between chronic headache and episodic headache or healthy controls. Significant difference was also found in FAB between chronic headache and healthy control(P=0.021). ANT showed that there were no significant differences in alerting,orienting or accuracy among three groups,but median response time was prolonged significantly in patients with chronic headache than those with episodic headache or healthy controls(P=0.002 or P=0.035),and compared with healthy controls,executive control function was also disrupt in chronic headache patients(P=0.042). Conclusion:Headache does disrupt attention function,especially in chronic headache,mainly for the average reaction time to perform tasks related to CH patients with prolonged attention,executive function decreased,suggesting that CH damaged the attention network-executive function,and these might be one of the key mechanisms of headache disrupting attention.
Objective:To investigate the clinical features and possible mechanisms of attention function in patients with episodic headache and chronic headache. Methods:Through a total of 18 patients with Episodic Headache(EH),20 patients with chronic headache(CH)and 21 healthy controls,respectively,neuropsychological assessment including mini mental state assessment scale(mini mental state exam,MMSE),Montreal cognitive assessment(China-Beijing edition Beijing Chinese version of Montreal Cognitive Assessment,Mo CA-C),digital span test(digit span test,DS),frontal lobe function rating scale(frontal assessment battery,FAB),the hospital anxiety and Depression Scale(hospital Anxiety and depression subscales,HADS)and Pittsburgh Sleep Scale(Pittsburgh sleep quality index,PSQI)and attention network test(attention networks test,ANT),and comparative analysis. Results:There were significant differences in Mo CA-C(P< 0.001 or P< 0.001),DS(P=0.002 or P=0.004),HADS(anxiety:P< 0.001 or P=0.002;depression:P< 0.001 or P=0.001)and PSQI(P< 0.001 or P=0.001)between chronic headache and episodic headache or healthy controls. Significant difference was also found in FAB between chronic headache and healthy control(P=0.021). ANT showed that there were no significant differences in alerting,orienting or accuracy among three groups,but median response time was prolonged significantly in patients with chronic headache than those with episodic headache or healthy controls(P=0.002 or P=0.035),and compared with healthy controls,executive control function was also disrupt in chronic headache patients(P=0.042). Conclusion:Headache does disrupt attention function,especially in chronic headache,mainly for the average reaction time to perform tasks related to CH patients with prolonged attention,executive function decreased,suggesting that CH damaged the attention network-executive function,and these might be one of the key mechanisms of headache disrupting attention.
引文
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[25]Fan J,Mc Candliss BD,Fossella J,et al.The activation of attentional networks[J].Neuroimage,2005,26(2):471-479
[26]Klinkenberg I,Sambeth A,Blokland A.Acetylcholine and attention[J].Behav Brain Res,2011,221(2):430-442
[27]Barbanti P,Aurilia C,Egeo G,et al.A case-control study on excessive daytime sleepiness in chronic migraine[J].Sleep Med,2013,14(3):278-281
[28]Sancisi E,Cevoli S,Vignatelli L,et al.Increased prevalence of sleep disorders in chronic headache:a case-control study[J].Headache,2010,50(9):1464-1472
[29]Zebenholzer K,Lechner A,Broessner G,et al.Impact of depression and anxiety on burden and management of episodic and chronic headaches-a cross-sectional multicentre study in eight Austrian headache centres[J].J Headache Pain,2016,17(1):15
[2]Attridge N,Eccleston C,Noonan D,et al.Headache impairs attentional performance:A conceptual replication and extension[J].J Pain,2017,18(1):29-41
[3]Ito S,Stuphorn V,Brown JW,et al.Performance monitoring by the anterior cingulate cortex during saccade countermanding[J].Science,2003,302(5642):120-122
[4]Headache Classification Committee of the International Headache S.The international classification of headache disorders,3rd edition(beta version)[J].Cephalalgia,2013,33(9):629-808
[5]张向荣,梅刚,廖文象,等.恢复期老年期抑郁症患者认知功能与日常生活能力相关性研究[J].南京医科大学学报(自然科学版),2014,34(11):1545-1549
[6]Macleod JW,Lawrence MA,Mc Connell MM,et al.Appraising the ANT:Psychometric and theoretical considerations of the Attention Network Test[J].Neuropsychology,2010,24(5):637-651
[7]Attridge N,Keogh E,Eccleston C.The effect of pain on task switching:pain reduces accuracy and increases reaction times across multiple switching paradigms[J].Pain,2016,157(10):2179-2193
[8]Moore DJ,Keogh E,Eccleston C.Headache impairs attentional performance[J].Pain,2013,154(9):1840-1845
[9]Qu P,Yu JX,Xia L,et al.Cognitive performance and the alteration of neuroendocrine hormones in chronic tensiontype headache[J].Pain Pract,2017[Epub ahead of print]
[10]Petersen SE,Posner MI.The attention system of the human brain:20 years after[J].Annu Rev Neurosci,2012,35(1);73-89
[11]Fan J,Mc Candliss BD,Sommer T,et al.Testing the efficiency and independence of attentional networks[J].J Cogn Neurosci,2002,14(3):340-347
[12]Berryman C,Stanton TR,Bowering KJ,et al.Do people with chronic pain have impaired executive function?A meta-analytical review[J].Clin Psychol Rev,2014,34(7):563-579
[13]Solberg Nes L,Roach AR,Segerstrom SC.Executive functions,self-regulation,and chronic pain:a review[J].Ann Behav Med,2009,37(2):173-183
[14]Ishigami Y,Eskes GA,Tyndall AV,et al.The Attention Network Test-Interaction(ANT-I):reliability and validity in healthy older adults[J].Exp Brain Res,2016,234(3):815-827
[15]Funahashi S,Andreau JM.Prefrontal cortex and neural mechanisms of executive function[J].J Physiol Paris,2013,107(6):471-482
[16]Crottaz-Herbette S,Menon V.Where and when the anterior cingulate cortex modulates attentional response:combined f MRI and ERP evidence[J].J Cogn Neurosci,2006,18(5):766-780
[17]Floresco SB,Magyar O.Mesocortical dopamine modulation of executive functions:beyond working memory[J].Psychopharmacology(Berl),2006,188(4):567-585
[18]Miller EK,Cohen JD.An integrative theory of prefrontal cortex function[J].Annu Rev Neurosci,2001,24:167-202
[19]Wiech K,Ploner M,Tracey I.Neurocognitive aspects of pain perception[J].Trends Cogn Sci,2008,12(8):306-313
[20]Schwedt TJ,Dodick DW.Advanced neuroimaging of migraine[J].Lancet Neurol,2009,8(6):560-568
[21]Schmitz N,Admiraal-Behloul F,Arkink EB,et al.Attack frequency and disease duration as indicators for brain damage in migraine[J].Headache,2008,48(7):1044-1055
[22]Gao Q,Xu F,Jiang C,et al.Decreased functional connectivity density in pain-related brain regions of female migraine patients without aura[J].Brain Res,2016,1632(1):73-81
[23]Lai TH,Protsenko E,Cheng YC,et al.Neural plasticity in common forms of chronic headaches[J].Neural Plast,2015,2015:205985
[24]Liossi C,Schoth DE,Godwin HJ,et al.Using eye movements to investigate selective attention in chronic daily headache[J].Pain,2014,155(3):503-510
[25]Fan J,Mc Candliss BD,Fossella J,et al.The activation of attentional networks[J].Neuroimage,2005,26(2):471-479
[26]Klinkenberg I,Sambeth A,Blokland A.Acetylcholine and attention[J].Behav Brain Res,2011,221(2):430-442
[27]Barbanti P,Aurilia C,Egeo G,et al.A case-control study on excessive daytime sleepiness in chronic migraine[J].Sleep Med,2013,14(3):278-281
[28]Sancisi E,Cevoli S,Vignatelli L,et al.Increased prevalence of sleep disorders in chronic headache:a case-control study[J].Headache,2010,50(9):1464-1472
[29]Zebenholzer K,Lechner A,Broessner G,et al.Impact of depression and anxiety on burden and management of episodic and chronic headaches-a cross-sectional multicentre study in eight Austrian headache centres[J].J Headache Pain,2016,17(1):15