Van der Werf Ysbrand D, Scheltens Philip, Lindeboom Jaap, Witter Menno P, Uylings Harry B M, Jolles Jelle
Department of Anatomy and Embryology, Graduate School for Neurosciences Amsterdam, Research Institute Neurosciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Neuropsychologia. 2003;41(10):1330-44. doi: 10.1016/s0028-3932(03)00059-9.
The thalamus plays a crucial role in memory, executive functioning and attention. It remains, however, unclear whether thalamic structures have specific roles in each of these functions. We tested 22 cases of thalamic infarction, proven with MR imaging, using experimental and established neuropsychological tests. We performed a lesion-overlap study in standardised stereotactic space of patients sharing a certain deficit, corrected for the lesion distribution of patients without such deficits and determined the regions of interest using an atlas of the human thalamus. We checked for additional, non-thalamic, damage and for deficient comprehension and perception that would preclude interpretation of the results. Non-thalamic damage such as white matter lesions, hippocampal atrophy, sulcal widening and infarctions occur significantly more often in patients aged over 60. The patients with additional damage overlapped to a major degree with those who showed loss of orientation, or lack of comprehension of the test requirements. In the 10 patients judged 'clean', we observed a deficit of episodic long-term memory with relative sparing of intellectual capacities and short-term memory when the mammillo-thalamic tract was damaged. Lesions including the medial dorsal nucleus, midline nuclei and/or intralaminar nuclei accompany executive dysfunctioning. Reduced simple processing speed and attention are associated with age, but not with a particular structure in the thalamus. Complex attention deficits follow damage to the intralaminar nuclei.We conclude that the analysis of structure-function relationships must take into account extra-structure damage which may explain cognitive deficits. Separate thalamic structures are involved in memory, executive functioning and attention.
丘脑在记忆、执行功能和注意力方面起着至关重要的作用。然而，丘脑结构在这些功能中是否各自具有特定作用仍不清楚。我们对22例经磁共振成像证实的丘脑梗死病例进行了实验性和既定的神经心理学测试。我们在共享某种缺陷的患者的标准化立体定向空间中进行了病损重叠研究，针对无此类缺陷的患者的病损分布进行了校正，并使用人类丘脑图谱确定了感兴趣区域。我们检查了是否存在额外的非丘脑损伤以及是否存在可能妨碍结果解释的理解和感知缺陷。60岁以上患者中，白质病变、海马萎缩、脑沟增宽和梗死等非丘脑损伤的发生率明显更高。有额外损伤的患者与出现定向障碍或不理解测试要求的患者在很大程度上重叠。在10例被判定为“无其他损伤”的患者中，我们观察到当乳头丘脑束受损时，情景长期记忆存在缺陷，而智力能力和短期记忆相对保留。包括背内侧核、中线核和/或板内核在内的病损伴随着执行功能障碍。简单加工速度和注意力的降低与年龄有关，但与丘脑中的特定结构无关。复杂注意力缺陷是由板内核受损引起的。我们得出结论，结构-功能关系的分析必须考虑到可能解释认知缺陷的结构外损伤。不同的丘脑结构分别参与记忆、执行功能和注意力。
