脑外伤认知障碍者神经心理学评价研究

目的探讨神经心理学检测指标在脑外伤者认知功能障碍评定中的应用价值。方法对脑外伤后认知障碍者进行中国修订韦氏成人智力量表、韦氏记忆量表及计算机化神经行为评价系统部分项目等神经心理学检测,按照原发性损伤程度和专家鉴定结论分别编组,对检测结果进行分析。结果损伤程度组填图、长时记忆、瞬时记忆、视觉保留及视简单反应时项目得分,轻型组高于中、重型组(P<0.05),其余项目(木块图、知识、相似、曲线吻合及数字筛选)组间差异无统计学意义。专家鉴定组中长时记忆、瞬时记忆、视觉保留、视简单反应时、曲线吻合及数字筛选得分值随认知功能障碍程度加重而逐渐降低,其中前4项组间差异具有统计学意义(P<0.05)。而韦氏智力测验4个项目较轻组与较重组得分接近,且均低于中度组,其中3项得分比较具有统计学差异(P<0.05)。结论原发性脑外伤与认知障碍严重程度有一定相关性,但相关检测项目显示不完全平行,在进行鉴定中应选择更为可靠的检测项目。

Evaluation research on neuropsychology in traumatic brain injury patients with congnitive impairment

Objective To explore the application value of neuropsychological tests during the evaluation of cognitive disorder in brain traumatic patients.Methods The neuropsychological test comprising partial items of Wechsler Intelligence Scale for Adult-Chinese Revised(WAIS-RC),Wechsler Memory Scale(WMS) and the fourth set of Computer-administered Neurobehavioral Evaluation System(NES-C4) were conducted,and then according to the degrees of their primary injury and the experts′ opinion independently,the patients were classified.Finally,the data were analyzed.Results The mild brain trauma group got significantly higher scores than the moderate and severe groups(P<0.05)in these items such as Plot Charting,Long-term Memory,Instant Memory,Visual Retention Test and Simple Visual Reaction Time,while no significant differences in scores of the other items among them grouped by their primary injuries.When the patients were grouped by experts' opinion,the scores were basically parallel to severity of cognitive disorder in those items such as Long-term Memory,Instant Memory,Visual Retention Test,Simple Visual Reaction Time,Curve Coincide and Figure Screening,and there were significant differences among the first four(P<0.05).The scores of mild group were close to the severe group′s in the four items of WAIS-RC,while three of them were significantly lower than the scores of moderate group(P<0.05).Conclusions The patient's severity of cognitive disorder was not completely parallel to his/her initial injury of brain trauma by neuropsychological evaluating test,and we must choose reliable items as objective auxiliary indicators In the psychiatric disability evaluation.