脑卒中急性期患者记忆、情绪与卒中部位的相关性研究
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摘要
脑卒中是现代社会发病率最高的疾病之一，卒中后大脑的局部损伤，不仅导致可测量的组织学改变，还引起神经心理学方面的变化。神经组织损伤可造成患者躯体感觉、运动功能障碍和严重的心理功能失调。同时，躯体功能受损还可引起和(／或)加重心理功能的紊乱。
记忆功能的损害是脑卒中患者神经心理学最明显的变化之一，由记忆功能损伤引发患者情绪、认知、行为的改变，后者又可加重记忆功能障碍，从而形成恶性循环，严重损害患者的社会功能与生活质量。
脑卒中的现代康复理论提倡早期肢体康复和心理功能康复。加快脑卒中患者的记忆力恢复和提高记忆力、改善不良情绪，最大限度地提高其社会再适应能力及生活质量是现代临床心理学和康复医学研究的热点问题。虽然对卒中后患者的记忆和情绪研究较多，但对于脑卒中急性期患者的研究相对较少。
本课题旨在研究：1．脑卒中急性期患者记忆的变化规律；2．脑卒中急性期患者内隐记忆与外显记忆的损伤特征；3．脑卒中急性期患者情绪障碍的特点；4．脑卒中急性期患者情绪与记忆的关系；5．不同卒中部位外显记忆与内隐记忆改变的特点以揭示不同脑区域对于记忆的贡献；6．脑卒中急性期患者记忆、情绪与不同基础性疾病的相关性。
本研究采用成组设计的对照研究，选用2005年3月至10月于山东省齐鲁医院神经内科住院的首次脑卒中患者(包括脑出血和脑梗塞)30名和年龄、受教育程度与患者组相匹配的正常老年人30名作为对照组。首先用长谷川痴呆量表进行筛查，排除痴呆患者，对被试进行一般资料的调查；由被试独立完成SAS、SDS；由调查者对被试进行汉密尔顿抑郁评分；利用临床记忆量表进行记忆力测试；后利用自制内隐记忆效应量表进行内隐记忆测试。
研究结果显示：1．患者记忆商、临床记忆量表分及分量表分均明显低于国
Stroke is one of the diseases which has the highest attack rate. The damages of brain not only induce the lesion in histology which can be measured but also induce changes in neuropsychology. Disorders of somatesthesia and locomotion and disturbance of mental function appeard when nerve tissue is injured. Meanwhile, the injury of somatesthesia can also aggrevate the disorder of mental function.
The abnormal of memory is the most evident thing, which can induce the corresponding changes of emotion, cognitive and behavioral, among the diverse changes in neuropsychology. The negative emotion, abnormal cognitive and behavioral can affect the society function and quality of life of patients.
In order to improve the patients'quality of life, rehabilitate the memory and reduce the bad emotion should be done.Although there are many investigation about memory and emotion of stroke patients, there are few research focus on the acute stage of those patients.
The purpose of this study is to investigate the implicit and explicit memory of stroke patients in acute stage; the relationship between memory and emotion; the feature of implicit and explicit memory and stroke focals to reveal the contribution of diffient encephalic region; the relations between memory, emotion and differ basical diseases.
30 patients who stroked with the first time and 30 normal aged people, whose age and years of education matched with the patients group participate in the study.Hastgawa Dementia Scale was used to screen and rule out the dementia; Then, investgate the general information of the objects; SAS, SDS and HAMD were used to investigate the negative emotion; The Clinical-Memory-Scale was
记忆功能的损害是脑卒中患者神经心理学最明显的变化之一，由记忆功能损伤引发患者情绪、认知、行为的改变，后者又可加重记忆功能障碍，从而形成恶性循环，严重损害患者的社会功能与生活质量。
脑卒中的现代康复理论提倡早期肢体康复和心理功能康复。加快脑卒中患者的记忆力恢复和提高记忆力、改善不良情绪，最大限度地提高其社会再适应能力及生活质量是现代临床心理学和康复医学研究的热点问题。虽然对卒中后患者的记忆和情绪研究较多，但对于脑卒中急性期患者的研究相对较少。
本课题旨在研究：1．脑卒中急性期患者记忆的变化规律；2．脑卒中急性期患者内隐记忆与外显记忆的损伤特征；3．脑卒中急性期患者情绪障碍的特点；4．脑卒中急性期患者情绪与记忆的关系；5．不同卒中部位外显记忆与内隐记忆改变的特点以揭示不同脑区域对于记忆的贡献；6．脑卒中急性期患者记忆、情绪与不同基础性疾病的相关性。
本研究采用成组设计的对照研究，选用2005年3月至10月于山东省齐鲁医院神经内科住院的首次脑卒中患者(包括脑出血和脑梗塞)30名和年龄、受教育程度与患者组相匹配的正常老年人30名作为对照组。首先用长谷川痴呆量表进行筛查，排除痴呆患者，对被试进行一般资料的调查；由被试独立完成SAS、SDS；由调查者对被试进行汉密尔顿抑郁评分；利用临床记忆量表进行记忆力测试；后利用自制内隐记忆效应量表进行内隐记忆测试。
研究结果显示：1．患者记忆商、临床记忆量表分及分量表分均明显低于国
Stroke is one of the diseases which has the highest attack rate. The damages of brain not only induce the lesion in histology which can be measured but also induce changes in neuropsychology. Disorders of somatesthesia and locomotion and disturbance of mental function appeard when nerve tissue is injured. Meanwhile, the injury of somatesthesia can also aggrevate the disorder of mental function.
The abnormal of memory is the most evident thing, which can induce the corresponding changes of emotion, cognitive and behavioral, among the diverse changes in neuropsychology. The negative emotion, abnormal cognitive and behavioral can affect the society function and quality of life of patients.
In order to improve the patients'quality of life, rehabilitate the memory and reduce the bad emotion should be done.Although there are many investigation about memory and emotion of stroke patients, there are few research focus on the acute stage of those patients.
The purpose of this study is to investigate the implicit and explicit memory of stroke patients in acute stage; the relationship between memory and emotion; the feature of implicit and explicit memory and stroke focals to reveal the contribution of diffient encephalic region; the relations between memory, emotion and differ basical diseases.
30 patients who stroked with the first time and 30 normal aged people, whose age and years of education matched with the patients group participate in the study.Hastgawa Dementia Scale was used to screen and rule out the dementia; Then, investgate the general information of the objects; SAS, SDS and HAMD were used to investigate the negative emotion; The Clinical-Memory-Scale was
引文
1．邱卓英，张爱民．《国际功能、残疾和健康分类》应用指导(一)[J]．中国康复理论与实践．2003，9(1)：20-37
2．陈小芳，孙月吉，刘启贵等．脑卒中后工作记忆损害[J]，中国心理卫生杂志，2005，19(8)：549-552
3．沈抒，谢欲晓，孙启良等．脑卒中患者行为记忆能力的临床分析[J]，中国康复医学杂志，2004，19(1)：22-24，48
4．王琨，程虹，丁新生．老年人脑卒中与记忆损害的关系，徐州医学院学报，2000，20(4)：302-303
5. Barba R, Martinez-Espinosa S, Rodriguez-Garcia E et al. Poststroke dementia clinical features and risk factors[J]. Stroke, 2000, 31 (7): 1494-1501
6. Ott B R, Saver J L. Unilateral amnesic stroke six new cases and a review of the literature. Stroke, 1993; 24(7): 1033-1042
7．郭起浩，王蓓，吕传真等．内囊-基底节区脑卒中后的记忆功能及相关因素[J]．中国心理卫生杂志，2002，16(9)：611-613
8．刁利华．脑梗塞、脑出血病人外显与内隐记忆的实验研究[J]，心理科学 1996，19(2)：90-92
9．郭力平，杨治良．内隐和外显记忆的发展研究[J]．心理科学，1998，21(4)：319-323
10．张晓明，于莉莉．脑外伤患者内隐记忆康复训练结果及其分析[J]，解放军护理杂志，1997，14(4)：57-59
11. Graf P. The information that amnesic patients do not forget[J], Exp. Psychol, 1984, 10(1), 164-178
12．张晓明，于莉莉．脑外伤患者内隐记忆康复护理可行性研究[J]，心理科学，1996，19(3)：167-169
13. Tranel D, Damasio A R, Damasio H et al. Sensorimotor skill learning in amnesia: Additional evidence for the neural basis of nondeclarative memory[J], Learning & Memory, 1994, 1(3): 165-179
14. Sinyor D, Amato P, Kaloupek DC et al.Poststroke depression relationships to functional impairmani, coping strategies and rehabilitation outcome[J], Stroke, 1986, 17 (6): 1102-1107
15. Vogel GH.Assessment and approach to treatment in post-stroke depression [J], L Am Aead Nurse Pract, 1995, 7(10): 493-497
16. Starksein SE, Robinson RG, Price TR.Compairison of patients with and without poststroke major depression matched for size and location of lesion [J].Arch Gen Psychiatry, 1998, 45 (3): 247
17. Gainolti G, Razzano C.The post-stroke depression rating scale: a tests-pecifically devised to ynvestigate affective disorder of strokepatients[J].J Clin Exp Neuropsychol, 1997, 19(3): 340-356
18. Robinson RG. The controversy over post-stroke depression and lesion location [J].Psychiatric Times, 2003, 20(7): 39-40
19. Carson AJ, Machale S, Allen K et al.Depression after stroke and lesion location: a systematic review [J].Lancet, 2000, 356(9224): 122-126
20. Angeleri F, Angeleri VA, Foschi N et al. Depression after stroke: an investigation through catamnesis[J].J Clin Psychiatry, 1997, 58(6): 261-265
21. Bhogal SK, Teasell R, Foley Net al. Lesion location and post-stroke depression: systematic review of the methodological limitations in the literature[J].Stroke, 2004, 35(3): 794-802
22. Aben I, Denollet J, Lousberg R et al.Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study[J].Stroke, 2002, 33(10): 2391-2395
23. Singh A, Black SE, Herrmann Net al. Functional and nerroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study[J].Stroke, 2000, 31(3): 637-644
24. 丁关庆.脑卒中伴发抑郁症 112 例研究[J]. 中国实用内科杂志, 1997, 17(11): 663
25. Dam H.Depression in stroke patients 7 years following stroke [J].Acta psychiatrScand, 2001, 103(4): 287-293
26. Tang WK, Chan SS, Chiu HF et al. Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly[J] J Affect Disord, 2004, 81(2): 153-156
27．李红玲，李应宽等．中风后抑郁症发病情况及影响因素的探讨[J]中国康复，1993，10(2)：62
28．贾艳滨，周迁璋．首发脑卒中后抑郁相关因素的临床研究[J]中国神经精神疾病杂志，1998，24(2)：66
29. Eich E, Metcalfe J .Emotion dependent memory for internal versus external events[J]. Experiment psychology: Learning, Memory, and cognition, 1989, 15 (2): 443-455
30. Erber R, Erber M W. Beyond emotion and social judgement: Emotion incongruent recall and emotion regulation[J]. European Journal of Social Psychology, 1994, 24 (2), 79-88
31. Eich E., Macaulay D, Ryan L. Mood dependent memory for events of the personal past. [J] Exp Psychol Gen. 1994 Jun; 123(2): 201-215.
32．谭忠林，柯永勤，曾国衍等．脑白质疏松老年人的认知功能[J]．中国神经精神疾病杂志，1999，25(5)：257-259
33. Carnwath TCM, Johnson DAW. Psychiatric morbidity among spouses of patients with stroke[J]. Br J Med, 1987, 294(3): 409-411
34．郭起浩，王蓓，吕传真等．内囊．基底节区脑卒中后的记忆功能及相关因素[J]，中国心理卫生杂志[J]，2002，16(9)：611-613
35．张华，贾志荣，王喜全等．基底节梗塞与出血对记忆影响的研究[J]，中国心理卫生杂志。1994，8(3)：105
36．俞子彬，孙九岭，桑瑞兰等．老年多发性脑梗塞记忆障碍的初步研究[J]，临床神经病学杂志，1992，5(4)：224
37．倪家鹤，刘文英．脑动脉硬化患者记忆功能障碍的对照研究[J]，中华神经精神科杂志，1990，23(4)：203
38．毕建忠，李义召，李大年．脑梗塞患者的记忆障碍[J]，山东医科大学学报， 1996，9，34(3)：93
39．常士芳，张子迪．脑梗塞患者的记忆障碍[J]，北京医学，1996，18(2)：126-127
40．张瑛，陈俊宁．脑卒中认知功能的神经心理学评估，国外医学·脑血管疾病分册，1996，4(4)：221
41．李振华，包仕尧．脑卒中后的抑郁症，国外医学·脑血管疾病分册，1996，4(1)：23
42．李振平．临床中枢神经解剖学，科学出版社，北京，2003，8，130-132
43. Eich E, Ryan L. Emotion dependence in implicit memory.Paper presented at psychonomics. New Orleans. (1990, November)
44．杨炯炯，翁旭初，管林初等．额叶参与对新异联系的启动效应[J]．心理学报，2002，34(1)：36-42
2．陈小芳，孙月吉，刘启贵等．脑卒中后工作记忆损害[J]，中国心理卫生杂志，2005，19(8)：549-552
3．沈抒，谢欲晓，孙启良等．脑卒中患者行为记忆能力的临床分析[J]，中国康复医学杂志，2004，19(1)：22-24，48
4．王琨，程虹，丁新生．老年人脑卒中与记忆损害的关系，徐州医学院学报，2000，20(4)：302-303
5. Barba R, Martinez-Espinosa S, Rodriguez-Garcia E et al. Poststroke dementia clinical features and risk factors[J]. Stroke, 2000, 31 (7): 1494-1501
6. Ott B R, Saver J L. Unilateral amnesic stroke six new cases and a review of the literature. Stroke, 1993; 24(7): 1033-1042
7．郭起浩，王蓓，吕传真等．内囊-基底节区脑卒中后的记忆功能及相关因素[J]．中国心理卫生杂志，2002，16(9)：611-613
8．刁利华．脑梗塞、脑出血病人外显与内隐记忆的实验研究[J]，心理科学 1996，19(2)：90-92
9．郭力平，杨治良．内隐和外显记忆的发展研究[J]．心理科学，1998，21(4)：319-323
10．张晓明，于莉莉．脑外伤患者内隐记忆康复训练结果及其分析[J]，解放军护理杂志，1997，14(4)：57-59
11. Graf P. The information that amnesic patients do not forget[J], Exp. Psychol, 1984, 10(1), 164-178
12．张晓明，于莉莉．脑外伤患者内隐记忆康复护理可行性研究[J]，心理科学，1996，19(3)：167-169
13. Tranel D, Damasio A R, Damasio H et al. Sensorimotor skill learning in amnesia: Additional evidence for the neural basis of nondeclarative memory[J], Learning & Memory, 1994, 1(3): 165-179
14. Sinyor D, Amato P, Kaloupek DC et al.Poststroke depression relationships to functional impairmani, coping strategies and rehabilitation outcome[J], Stroke, 1986, 17 (6): 1102-1107
15. Vogel GH.Assessment and approach to treatment in post-stroke depression [J], L Am Aead Nurse Pract, 1995, 7(10): 493-497
16. Starksein SE, Robinson RG, Price TR.Compairison of patients with and without poststroke major depression matched for size and location of lesion [J].Arch Gen Psychiatry, 1998, 45 (3): 247
17. Gainolti G, Razzano C.The post-stroke depression rating scale: a tests-pecifically devised to ynvestigate affective disorder of strokepatients[J].J Clin Exp Neuropsychol, 1997, 19(3): 340-356
18. Robinson RG. The controversy over post-stroke depression and lesion location [J].Psychiatric Times, 2003, 20(7): 39-40
19. Carson AJ, Machale S, Allen K et al.Depression after stroke and lesion location: a systematic review [J].Lancet, 2000, 356(9224): 122-126
20. Angeleri F, Angeleri VA, Foschi N et al. Depression after stroke: an investigation through catamnesis[J].J Clin Psychiatry, 1997, 58(6): 261-265
21. Bhogal SK, Teasell R, Foley Net al. Lesion location and post-stroke depression: systematic review of the methodological limitations in the literature[J].Stroke, 2004, 35(3): 794-802
22. Aben I, Denollet J, Lousberg R et al.Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study[J].Stroke, 2002, 33(10): 2391-2395
23. Singh A, Black SE, Herrmann Net al. Functional and nerroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study[J].Stroke, 2000, 31(3): 637-644
24. 丁关庆.脑卒中伴发抑郁症 112 例研究[J]. 中国实用内科杂志, 1997, 17(11): 663
25. Dam H.Depression in stroke patients 7 years following stroke [J].Acta psychiatrScand, 2001, 103(4): 287-293
26. Tang WK, Chan SS, Chiu HF et al. Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly[J] J Affect Disord, 2004, 81(2): 153-156
27．李红玲，李应宽等．中风后抑郁症发病情况及影响因素的探讨[J]中国康复，1993，10(2)：62
28．贾艳滨，周迁璋．首发脑卒中后抑郁相关因素的临床研究[J]中国神经精神疾病杂志，1998，24(2)：66
29. Eich E, Metcalfe J .Emotion dependent memory for internal versus external events[J]. Experiment psychology: Learning, Memory, and cognition, 1989, 15 (2): 443-455
30. Erber R, Erber M W. Beyond emotion and social judgement: Emotion incongruent recall and emotion regulation[J]. European Journal of Social Psychology, 1994, 24 (2), 79-88
31. Eich E., Macaulay D, Ryan L. Mood dependent memory for events of the personal past. [J] Exp Psychol Gen. 1994 Jun; 123(2): 201-215.
32．谭忠林，柯永勤，曾国衍等．脑白质疏松老年人的认知功能[J]．中国神经精神疾病杂志，1999，25(5)：257-259
33. Carnwath TCM, Johnson DAW. Psychiatric morbidity among spouses of patients with stroke[J]. Br J Med, 1987, 294(3): 409-411
34．郭起浩，王蓓，吕传真等．内囊．基底节区脑卒中后的记忆功能及相关因素[J]，中国心理卫生杂志[J]，2002，16(9)：611-613
35．张华，贾志荣，王喜全等．基底节梗塞与出血对记忆影响的研究[J]，中国心理卫生杂志。1994，8(3)：105
36．俞子彬，孙九岭，桑瑞兰等．老年多发性脑梗塞记忆障碍的初步研究[J]，临床神经病学杂志，1992，5(4)：224
37．倪家鹤，刘文英．脑动脉硬化患者记忆功能障碍的对照研究[J]，中华神经精神科杂志，1990，23(4)：203
38．毕建忠，李义召，李大年．脑梗塞患者的记忆障碍[J]，山东医科大学学报， 1996，9，34(3)：93
39．常士芳，张子迪．脑梗塞患者的记忆障碍[J]，北京医学，1996，18(2)：126-127
40．张瑛，陈俊宁．脑卒中认知功能的神经心理学评估，国外医学·脑血管疾病分册，1996，4(4)：221
41．李振华，包仕尧．脑卒中后的抑郁症，国外医学·脑血管疾病分册，1996，4(1)：23
42．李振平．临床中枢神经解剖学，科学出版社，北京，2003，8，130-132
43. Eich E, Ryan L. Emotion dependence in implicit memory.Paper presented at psychonomics. New Orleans. (1990, November)
44．杨炯炯，翁旭初，管林初等．额叶参与对新异联系的启动效应[J]．心理学报，2002，34(1)：36-42