男性腔隙性脑梗死患者的神经心理学及人格特点研究
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摘要
目的通过多种量表综合分析男性腔隙性脑梗死患者的认知功能、情绪状况、心理健康情况及人格特征,研究其神经心理学及人格特点。方法采取回顾性研究的方法,连续纳入2016年7～10月华中科技大学同济医学院附属同济医院门诊及住院男性腔隙性脑梗死患者(腔隙性脑梗死组) 96例及无腔隙性脑梗死男性(对照组) 55例,使用蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、症状自评量表(SCL-90)及艾森克人格问卷(EPQ),比较两组人群的神经心理学及人格特点。结果与对照组相比,腔隙性脑梗死组认知功能障碍者比率更高(P=0. 006),视空间与执行功能、命名、记忆、定向力评分及总得分均较低(P值分别0. 030,0. 020,0. 044,0. 046,P <0. 001);情绪评估显示,男性腔隙性脑梗死患者躯体性焦虑、躯体化因子、认识障碍因子、迟缓因子评分及HAMA、HAMD总分更高(P值分别为0. 021,0. 020,0. 014,0. 004,0. 011,0. 001);心理健康状况评估(SCI-90)显示,男性腔隙性脑梗死患者在躯体化因子、强迫症状、抑郁、焦虑4个因子及总均分得分更高(P值分别为0. 015,0. 001,0. 040,0. 004,P <0. 001);人格特点评估显示,男性腔隙性脑梗死患者神经质及精神质的得分更高(P=0. 029,0. 042)。结论男性腔隙性脑梗死患者的认知功能下降较为普遍,存在不良的神经心理学及人格特点。
Objective To study the neuropsychological and personality characteristics of male patients with lacunar infarction( LI) by analyzing the cognitive function,emotional status,mental health status and personality features. Methods A total of 96 male patients with LI( LI group) and 55 males without LI( control group) during July to October,2016 in the Department of Neurology,Tongji Hospital performed Mo CA,HAMA,HAMD,SCL-90 and EPQ evaluation in order to analyze their neuropsychological and personality characteristics. Results The proportion of cognitive impairment was significantly higher in LI group( P = 0. 006),and the scores of Visual Space and executive function,naming,memory and orientation factorsl were totally lower( P = 0. 030,0. 020,0. 044,0. 046,P < 0. 001). Multi-factor comparison showed the scores of somatic anxiety,somatic depression,cognitive disorder,delay factors and total scores of HAMA and HAMD were higher in LI group( P = 0. 021,0. 020,0. 014,0. 004,0. 011,0. 001). Mental health assessment suggested the scores of somatization,forced symptoms,depression,anxiety factors and general symptomatic indices were higher( P = 0. 015,0. 001,0. 040,0. 004,P < 0. 001). Personality evaluation showed that patients with LI had higher scores of neuroticism and psychoticism( P = 0. 029,0. 042). Conclusion The decline of cognitive level of LI in male patients with harmful neuropsychological and personality chaaracteristics is common.
Objective To study the neuropsychological and personality characteristics of male patients with lacunar infarction( LI) by analyzing the cognitive function,emotional status,mental health status and personality features. Methods A total of 96 male patients with LI( LI group) and 55 males without LI( control group) during July to October,2016 in the Department of Neurology,Tongji Hospital performed Mo CA,HAMA,HAMD,SCL-90 and EPQ evaluation in order to analyze their neuropsychological and personality characteristics. Results The proportion of cognitive impairment was significantly higher in LI group( P = 0. 006),and the scores of Visual Space and executive function,naming,memory and orientation factorsl were totally lower( P = 0. 030,0. 020,0. 044,0. 046,P < 0. 001). Multi-factor comparison showed the scores of somatic anxiety,somatic depression,cognitive disorder,delay factors and total scores of HAMA and HAMD were higher in LI group( P = 0. 021,0. 020,0. 014,0. 004,0. 011,0. 001). Mental health assessment suggested the scores of somatization,forced symptoms,depression,anxiety factors and general symptomatic indices were higher( P = 0. 015,0. 001,0. 040,0. 004,P < 0. 001). Personality evaluation showed that patients with LI had higher scores of neuroticism and psychoticism( P = 0. 029,0. 042). Conclusion The decline of cognitive level of LI in male patients with harmful neuropsychological and personality chaaracteristics is common.
引文
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[16]Cumming TB,Blomstrand C,Skoog I,et al.The High Prevalence of Anxiety Disorders After Stroke[J].Am J Geriatr Psychiatry,2016,24(2):154-60.
[17]Limampai P,Wongsrithep W,Kuptniratsaikul V.Depression after stroke at 12-month follow-up:a multicenter study[J].Int J Neurosci,2017,127(10):887-892.
[2]Arboix A,Blanco-Rojas L,Martí-Vilalta JL.Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke:translation of knowledge to prevention strategies[J].Expert Rev Neurother,2014,14(3):261-276.
[3]Zhang WN,Pan YH,Wang XY,et al.A prospective study of the incidence and correlated factors of post-stroke depression in China[J].Plo S One,2013,8(11):e78981.
[4]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点(1995)[J].临床和实验医学杂志,2013,12(7):559.
[5]Nasreddine ZS,Phillips NA,Bédirian V,et al.The Montreal Cognitive Assessment,Mo CA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.
[6]汪向东,姜长青,马弘.心理卫生评定量表手册(增订版)[M].中国心理卫生杂志社,1999:196-228.
[7]Ruis C,van den Berg E,van Stralen HE,et al.Symptom Checklist 90-Revised in neurological outpatients[J].J Clin Exp Neuropsychol,2014,36(2):170-177.
[8]王维治.神经病学[M].北京:人民卫生出版社,2013:1926.
[9]中国营养学会.中国居民膳食指南(2016)[M].北京:人民卫生出版社,2016:120-121.
[10]Vermeer SE,Prins ND,den Heijer T,et al.Silent brain infarcts and the risk of dementia and cognitive decline[J].N Engl J Med,2003,348(13):1215-22.
[11]Dhamoon MS,Mc Clure LA,White CL,et al.Long-term disability after lacunar stroke:secondary prevention of small subcortical strokes[J].Neurology,2015,84(10):1002-1008.
[12]Agic B,Mann RE,Tuck A,et al.Gender Differences in Alcohol Use and Risk Drinking in Ontario Ethnic Groups[J].J Ethn Subst Abuse,2015,14(4):379-391.
[13]Wang Z,Zhu M,Su Z,et al.Post-stroke depression:different characteristics based on follow-up stage and gender-a cohort perspective study from Mainland China[J].Neurol Res,2017,39(11):996-1005.
[14]Kitagawa K,Miwa K,Yagita Y,et al.Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors[J].Eur J Neurol,2015,22(1):187-192.
[15]Pendlebury ST,Cuthbertson FC,Welch SJ,et al.Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke:a population-based study[J].Stroke,2010,41(6):1290-1293.
[16]Cumming TB,Blomstrand C,Skoog I,et al.The High Prevalence of Anxiety Disorders After Stroke[J].Am J Geriatr Psychiatry,2016,24(2):154-60.
[17]Limampai P,Wongsrithep W,Kuptniratsaikul V.Depression after stroke at 12-month follow-up:a multicenter study[J].Int J Neurosci,2017,127(10):887-892.