轻度认知功能障碍患者的执行功能及事件相关电位的研究

目录1轻度认知功能障碍患者的执行功能和事件相关电位的研究 (1)1.1 中文摘要 (1)1.2 英文摘要 (3)1.3 前言 (6)1.4 1.5 1.6 材料与方法 (11)结果 (20)讨论 (33)1.7 结论 (50)1.8 参考文献 (51)1.9 英汉缩略词对照表 (58)2 致谢 (59)3轻度认知功能障碍的早期诊断的研究进展（综述） (60)轻度认知功能障碍患者的执行功能和事件相关电位的研究摘要目的：近年来对MCI患者认知功能中情节记忆，注意功能研究较多，而对MCI患者的执行能力研究相对较少且结论差异很大，MCI患者是否有执行能力损害及执行功能是全面受损还是局部受损，事件相关电位是否能够作为早期诊断指标均值得探讨。

本文旨在讨论MCI患者3个核心执行功能成分是否受损，事件相关电位与MCI患者执行功能损害的相关性。

寻找能够早期识别MCI执行功能障碍的客观方法，提高早期诊断轻度认知功能障碍的水平。

方法：60例研究对象，分为MCI组30例、对照组30例。

MCI 组患者符合Petersen 的轻度认知功能障碍的诊断标准。

对照组为30名年龄，受教育程度，性别与MCI组相匹配的正常老年人。

实验组和对照组完成下例测试：1、神经心理学量表测试：蒙特利尔认知量表（MoCA)、简明精神状态量表（MMSE）、临床痴呆评定量表（CDR）、听觉词语学习测验（AVLT）、画钟试验：（CDT）、连线测验:(TMT)；2、计算机辅助测试：斯特鲁普实验(Stroop实验) 、“2-back任务”；3、事件相关电位的测定：失匹配负波（MMN）与P300，采用spss17.0做统计分析。

结果：1．总体认知功能评价：轻度认知功能障碍患者与年龄，性别，教育相匹配的正常组相比，MCI患者其MMSE评分显著减退（P<0.01），且MoCA评分显著降低（P<0.01），MoCA以延迟记忆，视空间，执行功能损害为主； 2. 执行功能评价：2.1连线试验评估任务转换功能，MCI患者与NC组患者相比，连线试验B时间显著延长（P<0.01），干扰量增加（P<0.01）2.2画钟试验评估执行功能中的动作的计划性和抗干扰能力，MCI患者与NC组患者相比得分显著减少（P<0.01）2.3计算机辅助测试“2-back任务”评估工作记忆，结果显示MCI患者的“2-back任务”的错误率明显高于正常组（P<0.01）2.4计算机辅助测试stroop任务评估反应抑制，MCI患者与NC组相比，冲突条件下，MCI患者反应时明显延长（P<0.01），反应时干扰量较正常组延长（P<0.01），正确数干扰量较正常组减少（P<0.01）3.事件相关电位检测: MCI患者P300,MMN的潜伏期较NC患者明显延长（P<0.01），波幅较NC患者明显降低（P<0.01）4.轻度认知功能障碍患者的事件相关电位与神经心理学的相关性： MMN，P30O的潜伏期延迟与stroop的反应时干扰量，连线试验干扰量，2-back任务的错误率成正相关，与stroop正确率干扰量成负相关；MMN，P30O波幅降低与stroop的反应时干扰量，连线试验干扰量，2-back任务的错误率成负相关，与stroop正确率干扰量成正相关。

结论：1、轻度认知功能障碍患者总体认知功能评价发现：以延迟回忆，执行功能，视空间，注意损害为主，且MoCA是一个可以较好评价轻度认知功能障碍的评定工具。

2、计算机辅助检测：Stroop任务(反应抑制)，n-back 任务（工作记忆）及纸笔检测连线试验（任务转换）提示轻度认知功能障碍患者的反应抑制，工作记忆，任务转换功能均受损，执行功能全面损害。

3、事件相关电位P300，MMN与Stroop任务、n-back任务、连线试验均有良好的相关性，可以作为早期反应轻度认知功能障碍患者执行功能损害的神经电生理指标。

4、MMN，P300与神经心理学测验联合起来会大大提高轻度认知功能障碍患者执行功能障碍的诊断。

关键词：轻度认知障碍；执行功能；神经心理学测验；失匹配负波；P300The research of Executive function and event-related potentials in patients with mild cognitive impairmentAbstract：Objective:In recent years，there are more researches on the episodic memory and attention function in patients with MCI，and the research of executive ability in MCI patients is relatively less and the conclusion is different,Whether patients with MCI have the ability to perform damage and executive function is damaged or local damaged, and whether event related potentials can help early diagnosis are worth exploring. The purpose of this paper is to discuss whether the three core executive function in patients with MCI component is damaged, the correlation of event related potentials and executive function impairment in patients with MCI. Looking for the early recognition of MCI implementation of objective function, improve the level of early diagnosis of mild cognitive impairment. Methods: 60 cases of research objects, divided into MCI group of 30 cases, 30 cases in the control group. MCI patients met the diagnostic criteria of mild cognitive impairment of Petersen.The control group consisted of 30 age, education level, gender and MCI matched healthy elderly. All subjects completed the following test and tasks: 1, neuropsychological scale test: Montreal cognitive scale (MoCA), Mini-mental state examination (MMSE), clinical dementia rating scale (CDR), Auditory verbal learning test (AVLT), Clock-drawing test (CDT), Trail MakingTest (TMT); 2, computer auxiliary test: John stroup experiment (Stroop test), "2 - the back task"; 3, the determination of event related potential: mismatch negative wave (MMN) and P300. Results：1. Evaluation of the overall cognitive function in patients with mild cognitive impairment : MCI group with age, gender and education matched compared between the normal control group，the MMSE score was significantly decreased ( P<0.01 ), and the MoCA score decreased significantly ( P<0.01 ), MoCA to delay memory, visual space, executive function damage is given priority to.2.The executive function assessment:2.1 TMT test evaluation task switching function, MCI patients compared with NC group of patients, the TMT-B significantly prolonged (P < 0.01), the interference quantity increased (P < 0.01) 2.2 Clock-drawing test evaluation of executive function in action planning and anti-interference ability,compared with NC group of patients ,MCI patients score was significantly decreased (P < 0.01) 2.3 computer aided test "2 - the back task" assessment the refresh of working memory, results show that the MCI patients "2 - the back task" error rate is significantly higher than normal group (P < 0.01) 2.4 computer aided test stroop task assessment of response inhibition, MCI patients compared with NC group, under the condition of conflict, extended MCI patients with reaction time, reaction time disturbance variable extension in the normal group (P < 0.01), number of correct interference quantity is less than normal group (P < 0.01) 3. The event related potential detection: latency of P300 and MMN in patients with MCI patients is significantly longer than NCpatients (P < 0.01), amplitude of P300 and MMN in patients with MCI patients is significantly decreased (P < 0.01) 4. The correlation of neuropsychology and the event related potential in MCI:Reaction of MMN and P300 latency delay and stroop interference quantity,TMT interference quantity, error rate of the 2-back task into positive correlation , and correct stroop interference quantity into negative correlation; MMN and P300 amplitude reduce reaction time with stroop interference quantity, TMT interference quantity, error rate of the 2-back task is negative correlation , and correct stroop interference quantity into positive correlation .Conclusion: 1, Evaluation results general cognitive function in patients with mild cognitive impairment: delayed memory, executive functions, visual spatial attention, damage, and MoCA is a better evaluation of mild cognitive impairment assessment tools. 2, computer aided inspection: Stroop task (response inhibition task), n-back (working memory) and paper-and-pencil tests :TMT test (task switching) showed mild cognitive inhibition, working memory impairment in patients with reaction, task switching function are damaged, executive function overall damage. 3, event related potential P300 and MMN and Stroop task, n-back task, attachment test has good correlation, and can be used as a mild cognitive dysfunction in patients with early response executive function impairment of nerve electrophysiology index. 4, MMN, P300 and neuropsychological tests together will greatly enhance the diagnosis of mild cognitive impairment in patients with executive dysfunction.Key words: mild cognitive impairment/ Executive function/ Mismatch negative wave/ P300/ Neuropsychological test;前言随着社会进步和人们生活水平的提高，人类的寿命明显延长。