卒中后失语患者非语言认知功能损害特点的临床研究
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摘要
目的探讨卒中后失语患者非语言认知功能损害的特点,并分析卒中后失语患者语言障碍与非语言性认知功能损害之间的关系。方法选择2017年5月-2018年6月就诊的卒中患者共32例,经西方失语症成套测验(westernaphasia battery,WAB)评估语言功能,分为失语组和无失语组,其中失语组15例,无失语组17例。洛文斯顿成套测验中文版(Loewenstein occupational therapy cognitive assessment,LOTCA)第2版评估患者非语言认知功能。对失语组与非失语组的LOTCA各分项分值及总分分别进行非参数检验;对WAB中各分项得分及失语商与LOTCA各认知分项得分及总分进行偏相关分析,并行多元逐步回归分析。结果失语组的LOTCA总分低于无失语组,差异有统计学意义[85.0(69.0～92.0)分vs99.0(86.0～102.5)分,P<0.05];失语患者LOTCA总分与WAB各分项及失语商呈正相关(r=0.587～0.883,均P<0.05),WAB分项中的各分项与LOTCA中各分项之间呈正相关(r=0.521～0.843,均P<0.05);多元逐步回归分析显示,影响患者失语商的主要因素为LOTCA总分(β=0.707,P=0.003)。结论卒中后失语患者存在非语言认知功能障碍,失语程度越重其非语言认知功能受损程度越重。
Objective To explore the characteristics of non-linguistic cognitive impairment in patients with post-stroke aphasia, and to analyze the relationship between language impairment and nonlinguistic cognitive impairment in patients with aphasia after stroke.Methods Thirty-two patients with stroke in Beijing Tian Tan Hospital were selected. The language function of all the patients during hospitalization were assessed by Western Aphasia Battery(WAB),and they were divided into aphasia group(n=15) and non-aphasia group(n=17). The non-linguistic cognitive function were assessed by the second edition of the Chinese version of Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery. The sub-item and total scores of LOTCA in the two groups were compared, and the sub-item scores of WAB and the sub-item and total scores of LOTCA were analyzed by partial correlation analysis. Parallel multiple stepwise regression analysis was conducted to identify the factors influencing aphasic quotient.Results The total score of LOTCA in aphasia group was significantly lower than that in non-aphasia group [85.0(69.0-92.0) vs 99.0(86.0-102.5), P<0.05]. The total score of LOTCA were positively correlated with WAB sub-item scores and aphasia quotient(r=0.587-0.883, P<0.05), the sub-item scores of LOTCA were positively correlated with WAB sub-item scores(r=0.521-0.843, P<0.05), and multiple stepwise regression analysis showed that the main factor affecting aphasia quotient was the total score of LOTCA(β=0.707, P=0.003).Conclusions There is non-linguistic cognitive impairment in patients with aphasia after stroke. The more severe aphasia, the more severe non-linguistic cognitive impairment.
Objective To explore the characteristics of non-linguistic cognitive impairment in patients with post-stroke aphasia, and to analyze the relationship between language impairment and nonlinguistic cognitive impairment in patients with aphasia after stroke.Methods Thirty-two patients with stroke in Beijing Tian Tan Hospital were selected. The language function of all the patients during hospitalization were assessed by Western Aphasia Battery(WAB),and they were divided into aphasia group(n=15) and non-aphasia group(n=17). The non-linguistic cognitive function were assessed by the second edition of the Chinese version of Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery. The sub-item and total scores of LOTCA in the two groups were compared, and the sub-item scores of WAB and the sub-item and total scores of LOTCA were analyzed by partial correlation analysis. Parallel multiple stepwise regression analysis was conducted to identify the factors influencing aphasic quotient.Results The total score of LOTCA in aphasia group was significantly lower than that in non-aphasia group [85.0(69.0-92.0) vs 99.0(86.0-102.5), P<0.05]. The total score of LOTCA were positively correlated with WAB sub-item scores and aphasia quotient(r=0.587-0.883, P<0.05), the sub-item scores of LOTCA were positively correlated with WAB sub-item scores(r=0.521-0.843, P<0.05), and multiple stepwise regression analysis showed that the main factor affecting aphasia quotient was the total score of LOTCA(β=0.707, P=0.003).Conclusions There is non-linguistic cognitive impairment in patients with aphasia after stroke. The more severe aphasia, the more severe non-linguistic cognitive impairment.
引文
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[14]SENIóW J,LITWIN M,LE?NIAK M.The relationship between non-linguistic cognitive deficits and language recovery in patients with aphasia[J].JNeurol Sci,2009,283(1):91-94.
[15]高素荣.失语症[M].北京:北京大学医学出版社,第二版,2006:11.
[16]BONINI M V,RADANOVIC M.Cognitive deficits in post-stroke aphasia[J].Arq Neuropsiquiatr,2015,73(10):840-847.
[17]王茜,刘晓加,王琪,等.脑卒中后失语患者认知功能评估的相关因素研究及年龄差异[J].中华神经医学杂志,2016,15(6):598-603.
[2]FORKEL S J,CATANI M.Lesion mapping in acute stroke aphasia and its implications for recovery[J/OL].Neuroquantology,2018,115:88-100.https://doi.org/10.1016/j.neuropsychologia.2018.03.036.
[3]BALDO J V,DRONKERS N F,WILKINS D,et al.Is problem solving dependent on language?[J].Brain Lang,2005,92(3):240-250.
[4]中华医学会神经科分会.脑血管疾病的诊断要点[J].中华神经科杂志,1996,29(6):371-379.
[5]KIM H K,HWANG Y J,刘巧云,等.失语症定义和失语症评估[J].中国听力语言康复科学杂志,2013,11(1):62-65.
[6]燕铁斌,马超,郭友华,等.Loewenstein认知评定量表(简体中文版)的效度及信度研究[J].中华物理医学与康复杂志,2004,26(2):81-84.
[7]ROBEY R R.A meta-analysis of clinical outcomes in the treatment of aphasia[J].J Speech Lang Hear Res,1998,41(1):172-187.
[8]CODE C.Multifactorial processes in recovery from aphasia:developing the foundations for a multileveled framework[J].Brain Lang,2001,77(1):25-44.
[9]阚璠,戴立磊,成逸.记忆广度训练对脑梗死后感觉性失语症患者语句听理解能力的疗效观察[J].护理与康复,2017,16(11):1184-1186.
[10]邢松丽.重型颅脑外伤后失语患者认知功能特点分析[J].中国实用神经疾病杂志,2016,19(21):88-89.
[11]HALAI A D,WOOLLAMS A M,LAMBONRALPH M A.Triangulation of language-cognitive impairments,naming errors and their neural bases post-stroke[J/OL].Neuroimage Clin,2018,17:465-473.https://doi.org/10.1016/j.nicl.2017.10.037.
[12]CAPLAN D,MICHAUD J,HUFFORD R.Short Term Memory,Working Memory,and Syntactic Comprehension in Aphasia[J].Cogn Neuropsychol,2013,30(2):77-109.
[13]GOLDENBERG G,RANDERATH J.Shared neural substrates of apraxia and aphasia[J/OL].Neuropsychologia,2015,75:40-49.https://doi.org/10.1016/j.neuropsychologia.2015.05.017.
[14]SENIóW J,LITWIN M,LE?NIAK M.The relationship between non-linguistic cognitive deficits and language recovery in patients with aphasia[J].JNeurol Sci,2009,283(1):91-94.
[15]高素荣.失语症[M].北京:北京大学医学出版社,第二版,2006:11.
[16]BONINI M V,RADANOVIC M.Cognitive deficits in post-stroke aphasia[J].Arq Neuropsiquiatr,2015,73(10):840-847.
[17]王茜,刘晓加,王琪,等.脑卒中后失语患者认知功能评估的相关因素研究及年龄差异[J].中华神经医学杂志,2016,15(6):598-603.