Objectives: To comprehensively analyze the characteristics of cognitive impairment of temporal lobe epilepsy (TLE), and to explore the effects of different lateral patients' cognitive impairment and different clinical factors on cognitive impairment of TLE.
Methods: A total of 84 patients, who met the diagnostic criteria for TLE in the Department of Neurology, Xiangya Hospital, were collected as a patient group, with 36 cases of left TLE and 48 cases of right TLE. A total of 79 healthy volunteers with matching gender, age and education level were selected as a control group. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the scores of Arithmetic Test, Information Test, Digit Symbol Substitution Test (DSST), Block Design Test (BDT), Hayling Test and Verbal Fluency Test (VFT) of the revised Chinese Adult Wechsler Intelligence scale were retrospectively analyzed in the 2 groups.Multiple regression analysis was used to analyze the relationship between the clinical factors and the cognitive impairment score.
Results: Compared with the control group, the TLE patient group had low scores in all neuropsychological tests, with significant difference (all P<0.05). Compared with the control group, there was significant difference in different neuropsychological tests in the patients with TLE on different sides (all P<0.05). In the left TLE, there were low scores in Information Test, arithmetic, VFT, the completion time of Hayling Test part A, the completion time of Hayling Test part B, the correct number of Hayling Test part A, the correct number of Hayling Test part B, BDT, Forward Digit Span Test (FDST) and Backward Digit Span Test (BDST). While in the right TLE, there were low scores in Information Test, arithmetic, DSST, VFT, the completion time of Hayling Test part A, the correct number of Hayling Test part A, the completion time of Hayling Test part B, the correct number of Hayling Test part B, BDT, FDST and BDST.
Conclusions: There are multiple cognitive domain dysfunctions in TLE, including language, short-term memory, long-term memory, attention, working memory, executive function and visual space function. Left TLE has greater impairment of executive function and right TLE has greater damage in working memory. Long pathography of disease, hippocampal sclerosis and a history of febrile convulsions may lead to more severe cognitive impairment. Earlier identification and earlier intervention are needed to improve prognosis of patients.
目的: 分析颞叶癫痫(temporal lobe epilepsy，TLE)认知功能障碍的特点、不同侧TLE认知障碍以及不同临床因素对TLE认知障碍的影响。方法: 收集中南大学湘雅医院神经内科门诊符合TLE诊断标准的84例患者作为患者组，左侧TLE 36例，右侧TLE 48例；选取同期性别、年龄和学历匹配的79名健康志愿者作为对照组。分析两组的简易智能精神状态检查量表(Mini-Mental State Examination，MMSE)，蒙特利尔认知评估量表(Montreal Cognitive Assessment，MoCA)，中国修订成人韦氏智力量表的算术测试(Arithmetic Test)、知识(Information Test)、数字符号(Digit Symbol Substitution Test，DSST)、数字广度(Forward Digit Test，FDT)及木块图量表(Block Design Test，BDT)、连线测试(Trail Making Test，TMT)、海林试验(Hayling Test)和语言流畅实验(Verbal Fluency Test，VFT)的评分情况。运用多元回归分析临床因素与认知障碍评分的关系。结果: 与对照组相比，TLE患者组的所有神经心理学测试评分均较低，差异均有统计学意义(均P<0.05)。左侧与右侧TLE患者分别与对照组相比，在所有神经心理学测试评分中差异均有统计学意义(均P<0.05)，其中左侧TLE患者的知识、算术、VFT、Hayling Test A部分完成时间、Hayling Test B部分完成时间、Hayling Test A部分正确数、Hayling Test B部分正确数、BDT、顺背数字广度实验(Forward Digit Span Test，FDST)和倒背数字广度测试(Backward Digit Span Test，BDST)评分较低；右侧TLE患者的知识、算术、DSST、VFT、Hayling Test A部分完成时间、Hayling Test A部分正确数、Hayling Test B部分完成时间、Hayling Test B部分正确数、BDT、FDST及BDST评分较低。结论: TLE存在语言、短期记忆、远期记忆、注意力、工作记忆、执行功能及视空间多个认知领域功能障碍；左侧TLE执行功能损害更大，右侧TLE存在工作记忆损害更大。病程长、海马硬化及高热惊厥病史可能会导致更严重的认知障碍，需早期识别和及早干预以改善患者预后。.
Keywords: cognitive dysfunction; influencing factor; temporal lobe epilepsy.