Decision-Making Impairment on the Iowa Gambling Task After Endovascular Coiling or Neurosurgical Clipping for Ruptured Anterior Communicating Artery Aneurysm
Decision-Making Impairment on the Iowa Gambling Task After Endovascular Coiling or Neurosurgical Clipping for Ruptured Anterior Communicating Artery Aneurysm
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DOI：
10.1037/a0024336
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发表时间：
2012-03-01
期刊：
影响因子：
2.4
通讯作者：
Rubio, Francisco
中科院分区：
文献类型：
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作者：
Escartin, Gemma;Junque, Carme;Rubio, Francisco
目的：研究前交通动脉瘤（ACoA）破裂后的决策缺陷，并比较两种治疗方法的效果。方法：样本包括40例继发于前交通动脉瘤破裂的蛛网膜下腔出血患者，神经系统结局良好，对照组包括31例年龄、性别和受教育年限匹配的受试者。20例患者接受了手术干预（夹闭），20例接受了血管内治疗。决策由爱荷华州赌博任务（IGT）进行评估。我们使用期望效价模型来研究与IGT相关的不同成分。结果：ACoA患者在IGT中的表现明显差于对照组，我们观察到70%的患者在IGT中表现不佳。根据干预类型比较各组，我们发现，夹闭组患者在JOT上的表现明显差于对照组，而弹簧圈栓塞组患者与对照组或夹闭组患者没有显著差异;然而，弹簧圈栓塞组患者在任务的最后一个模块上的表现差于对照组。额叶损伤的患者从不利的牌组中选择了更多的牌。IGT与威斯康星州卡片分类测验中的持续错误和非持续错误、言语流畅性测验等执行功能测验成绩相关，但与工作记忆测验成绩不相关。根据期望效价模型，额叶病变患者表现出更大的倾向于关注最近的结果，忽略或迅速忽视过去的结果，并且倾向于具有更不稳定的反应模式。结论：我们的研究结果表明，继发于前交通动脉破裂的蛛网膜下腔出血患者在模糊情况下的决策能力存在缺陷。这种缺陷的主要原因是额叶病变的存在。此外，与对照组相比，夹闭患者（而非弹簧圈患者）在决策方面表现出缺陷。我们的研究结果表明，IGT可能有助于确定这些患者的神经心理后遗症。
Objective: To investigate decision-making deficits after anterior communicating artery aneurysm (ACoA) rupture and to compare the effects of two treatments. Method: The sample included 40 patients with subarachnoid hemorrhage secondary to ruptured ACoA with a favorable neurological outcome and a control group of 31 subjects matched by age, sex, and years of education. Twenty patients had surgical interventions (clipping) and 20 had received endovascular treatment. Decision-making was assessed by the Iowa Gambling Task (IGT). We used the Expectancy Valence model to examine the different components associated with the IGT. Results: ACoA patients performed significantly worse on the IGT than controls, we observed poorly performance on IGT in 70% of the patients. Comparing the groups according to type of intervention, we found that clipped patients performed significantly worse than controls on the JOT, whereas coiled patients did not differ significantly from controls or clipped patients; however, coiled patients performed worse than controls on the last block of the task. Patients with frontal lesions selected significantly more cards from the disadvantageous deck. IGT performance correlated with other tests of executive functions such as the perseverative errors and non perseverative errors of Wisconsin Card Sorting Tests, and verbal fluency test, but not with working memory tests. According to the Expectancy Valence model, patients with frontal lesions showed a greater tendency to focus on recent outcomes and ignore or rapidly discount past outcomes, and tended to have a more erratic response pattern. Conclusions: Our results suggest that patients with subarachnoid hemorrhage secondary to ruptured ACoA have deficits in decision-making under ambiguity. The main cause of this deficit is the presence of frontal lesions. Moreover, clipped patients, but not coiled patients, showed deficits in taking decisions in comparison with controls. Our results suggest that the IGT may help to identify neuropsychological sequelae in these patients.