顱內動脈瘤破裂引發蜘蛛網膜下腔出血對患者認知功能影響之探討

本研究主要目的是要了解30位顱內動脈瘤破裂引發蜘蛛網膜下腔出血患者接受手術及臨床治療後至少六個月，GCS恢復至15分，認知功能缺損程度及情緒狀態情形，並探討與常模及59位正常控制組比較後之差異，同時亦比較前循環區動脈瘤患者與後循環區動脈瘤患者在認知功能及情緒表現之差異。本研究採用標準化且常在臨床使用的神經心理測驗來評量認知功能五個向度，包括注意力、視覺空間視覺結構、語言能力、語言記憶及執行功能。測驗包括：(1)魏氏成人智力量表第三版(WAIS-Ⅲ)中文版之記憶廣度分測驗、數字-符號替代分測驗、圖形設計分測驗；(2)R-O繪圖測驗；(3)魏氏記憶量表第三版(WMS-Ⅲ)中文版之邏輯記憶分測驗Ⅰ＆Ⅱ；(4) Luria接受性及表達性語言分測驗；和(5)衛斯康辛卡片分類測驗。此外，本研究亦採用貝克憂鬱量表、情境焦慮及特質焦慮量表以得知病患組之情緒狀態。研究結果發現病患組在記憶廣度分測驗、數字－符號替代分測驗、圖形設計分測驗、R-O繪圖測驗、邏輯記憶Ⅰ＆Ⅱ故事分測驗與常模相比皆顯著較差(p＜.001)。在衛斯康辛卡片分類測驗之(固執性反應數、概念程度反應數、所完成的卡片分類數、第一個分類所需的卡片數、Luria接受性及表達性語言測驗的表現亦顯著比正常控制組差(p＜.001)。利用探索性因素分析，將五個向度總分抽取成一個共同因素稱之為認知功能，因此整體而言病患組的認知功能皆顯著比常模及正常控制組差。前循環區動脈瘤患者與後循環區動脈瘤患者在認知功能表現未達顯著水準(p=.998)，即表示兩組病患組的認知功能無顯著差異；在憂鬱情緒、情境焦慮、特質焦慮之表現達顯著水準(p=.000)，表示憂鬱或焦慮情緒表現會隨著組別的不同而有顯著差異。在病患組變項中，包括水腦症的有無(p=.710)、腦室引流管植入的有無(p=.967)在認知功能之表現未達顯著水準，所以認知功能不會隨著變項的不同而有顯著差異；另外，在清醒天數方面達顯著水準(p＝.012)，顯示整體而言，病患組從昏迷指數未滿分到達滿分之清醒天數會隨著天數的不同使認知功能的表現有顯著差異。在情緒狀態方面，上述三種變項在憂鬱量表、情境焦慮及特質焦慮量表的分數未達顯著水準(p＞.05)，因此病患組在情緒表現上並不會因上述三種變項的不同而有顯著差異。本研究亦發現，病患組從昏迷指數未滿分到達滿分之清醒天數會隨著水腦症的發生及腦室引流管的植入而有天數增加之趨勢。在工作狀態方面，病患組30名受試者中，顯示有將近2/3患者手術後無法返回原工作崗位。這些研究結果將可作為臨床工作者評估治療之成效及出院後擬定計劃的參考。關鍵詞：顱內動脈瘤、蜘蛛網膜下腔出血、認知功能、神經心理測驗

關鍵字

顱內動脈瘤；蜘蛛網膜下腔出血；認知功能；神經心理測驗

並列摘要

The purpose of this study was to evaluate cognition function and mood status in 30 aneurysmal SAH patients. Patients were eligible for entrance in the study if the following inclusion criteria were met: a diagnosis of aneurysmal SAH, a Glasgow Coma Scale score of 15 at study inclusion, and 6 months post onset. The other purpose was to compare the performance differences in neuropsychological tests and mood measures between 59 age-matched normal controls. To compare performance differences in cognition function and mood status between patients with anterior circulation aneurysms and posterior circulation aneurysms. Cognitive functions can be broadly devided into five domains: attention and concentration, visuospatial and visuoconstructive functions, language, memory and executive function. The tests chosen for this study were reliable, valid, and commonly used in the clinical practice, including(1) the Chinese version of the Wechsler Adult Intelligence Scale-Ⅲ－digit span, digit symbol, block design subtests；(2) the Chinese version of the Wechsler Memory scale-Ⅲ－logical memory subtests Ⅰ＆Ⅱ；(3) Rey-Osterreith Complex Figure Test；(4) receptive & expressive speech scales of the Luria-Nebraska Neuropsychological Battery, and (5) the Wisconsin Card Sorting Test. In addition, the Beck Depression Inventory and State-Trait Anxiety Inventory were employed to assess patient’s mood. Results of our analysis revealed that the normal controls performed better than both patient groups in digit span, digit symbol, block design, logical memory subtests Ⅰ＆Ⅱ subtest, Rey-Osterreith Complex Figure Test, Luria-Nebraska receptive & expressive speech scales, and Wisconsin Card Sorting Test (perseverative responses；PR、conceptual-level responses；CLR、number of categories completed；NCC、trials to complete the first catagory；TCC) (p＜.001). The results showed that patient groups performed significantly worse than the control group in five cognition domains(p＜.001).In cognitive functions, significant differences in the neuropsychological performance were not noted between patients with anterior circulation aneurysms and posterior circulation aneurysms (p=.998).In affective measurements, significant differences in depression mood , state-trait anxiety performance were noted between patients with anterior circulation aneurysms and posterior circulation aneurysms (p=.000). However, cognitive dysfunction reduced employment rates are frequency noted and mood disturbances of interpersonal relationships have been a significant concern. Key Words：Intracranial aneurysms, subarachnoid hemorrhage(SAH), Cognitive function, Neuropsychological test