Bell's or Friedreich's palsy
Bell's or Friedreich's palsy
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贝尔氏或弗里德赖希氏麻痹
DOI：
10.1136/jnnp.67.6.732
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
B. Sahakian
中科院分区：
文献类型：
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作者：
Joanna L. Iddon;J. Pickard;J. Cross;P. Griffiths;M. Czosnyka;B. Sahakian
目的：从43例原发性常压脑积水（NPH）患者中选择11例。NPH患者分为两个不同的亚组：1组（n=5）在最小精神状态检查（MMSE）得分低于24分，归类为痴呆；2组（n=6）在MMSE得分24分及以上，归类为非痴呆。方法所有患者分别在分流术前和分流术后6个月进行神经心理评估。组1完成迷你心理状态测验（MMSE）和Kendrick对象学习测验（KOLT）。除了MMSE和KOLT之外，第二组还完成了其他任务，包括语言流畅性和CANTAB电池的记忆和注意力任务。11例患者中有9例也接受了分流后MRI检查。结果第1组，目前在MMSE和KOLT的失智范围内，显示出明显的术后恢复，所有患者现在的评分都在正常的非失智范围内。第二组，尽管根据MMSE和KOLT在分流术前后均未显示出痴呆的迹象，但与健康志愿者相比，在对额纹状体功能障碍敏感的测试中确实显示出一种特定的损伤模式，并且这种模式在术后仍然存在。重要的是，这种模式与轻度阿尔茨海默病患者的表现不同。九种结构损伤模式中的八种与认知表现相吻合。结论：这些发现有三个主要原因：(1)它们详细描述了NPH中所见损伤的结构和功能特征，(2)它们证明了该人群中发现的异质性，并显示了初始认知损伤的严重程度如何影响分流手术后的结果，(3)它们可能为分流手术中新手术的认知结果提供信息并提供一种监测方法。
OBJECTIVES Eleven patients with idiopathic normal pressure hydrocephalus (NPH) were selected from an initial cohort of 43 patients. The patients with NPH fell into two distinctive subgroups: preshunt, group 1 (n=5) scored less than 24 on the mini mental state examination (MMSE) and were classified as demented and group 2 (n=6) scored 24 or above on the MMSE and were classified as non-demented. METHODS All patients were neuropsychologically assessed on two occasions: preshunt and then again 6 months postshunt. Group 1 completed the mini mental state examination (MMSE) and the Kendrick object learning test (KOLT). In addition to the MMSE and KOLT, group 2 completed further tasks including verbal fluency and memory and attentional tasks from the CANTAB battery. Nine of the 11 patients also underwent postshunt MRI. RESULTS Group 1, who, preshunt, performed in the dementing range on both the MMSE and KOLT, showed a significant postoperative recovery, with all patients now scoring within the normal non-demented range. Group 2, although showing no signs of dementia according to the MMSE and KOLT either preshunt or postshunt, did show a specific pattern of impairment on tests sensitive to frontostriatal dysfunction compared with healthy volunteers, and this pattern remained postoperatively. Importantly, this pattern is distinct from that exhibited by patients with mild Alzheimer's disease. Eight of the nine patterns of structural damage corresponded well to cognitive performance. CONCLUSIONS These findings are useful for three main reasons: (1) they detail the structural and functional profile of impairment seen in NPH, (2) they demonstrate the heterogeneity found in this population and show how severity of initial cognitive impairment can affect outcome postshunt, and (3) they may inform and provide a means of monitoring the cognitive outcome of new procedures in shunt surgery.