Serber Stacy L, Kumar Rajesh, Woo Mary A, Macey Paul M, Fonarow Gregg C, Harper Ronald M
School of Nursing, David Geffen School of Medicine, University of California at Los Angeles, CA 90095-1763, USA.
Nurs Res. 2008 Mar-Apr;57(2):75-83. doi: 10.1097/01.NNR.0000313483.41541.10.
Cognitive impairment, assessed using paper-and-pencil tests, occurs with multiple syndromes, including heart failure; however, relationships between test performance and brain injury are unclear.
To determine the extent of brain injury assessed by magnetic resonance T2 relaxometry procedures in a mixed sample with cognitive impairment as measured by the Mini-Mental State Examination, Trailmaking Test parts A (TMT-A) and B (TMT-B), and the Watson Clock-Drawing Test (CDT).
A comparative design was used with a convenience sample of 66 participants (age 48.2 +/- 8.4 years, 41 males, 52 right-handed). Normal and abnormal performances on cognitive tests were compared using T2 relaxation values across the brain (p < .005). Fifty-four of the participants were healthy, and 12 had heart failure (New York Heart Association classes II-III, left ventricular ejection fraction <0.40).
All participants scored normally on the Mini-Mental State Examination; thus, this test was excluded from further analysis. Abnormal cognitive scores were found in 14-20% of the participants, with significant brain injury appearing in participants with abnormal test scores. Injured structures included frontal, temporal, parietal, insular, and cingulate cortices; corpus callosum; and caudate. The CDT results showed the greatest extent of structural injury. The TMT-A test demonstrated relationships to specific injury sites, whereas the TMT-B showed relationships only to isolated areas of damage.
The findings suggest that paper-and-pencil cognitive tests relate to injury in brain structures, with CDT values relating to the greatest extent of injury. Specific damage sites may correlate with unique tests, such as TMT-A. Specialized tests should be developed that would indicate neural injury in specific areas.
使用纸笔测试评估的认知障碍会出现在多种综合征中，包括心力衰竭；然而，测试表现与脑损伤之间的关系尚不清楚。
通过磁共振T2弛豫测量程序，确定在一个混合样本中脑损伤的程度，该样本的认知障碍通过简易精神状态检查表、A部分连线测验（TMT-A）、B部分连线测验（TMT-B）和沃森钟表绘制测验（CDT）进行测量。
采用比较设计，选取66名参与者的便利样本（年龄48.2±8.4岁，41名男性，52名右利手）。使用全脑的T2弛豫值比较认知测试的正常和异常表现（p<0.005）。54名参与者健康，12名患有心力衰竭（纽约心脏协会II-III级，左心室射血分数<0.40）。
所有参与者在简易精神状态检查表上得分均正常；因此，该测试被排除在进一步分析之外。14%-20%的参与者认知得分异常，测试得分异常的参与者出现了明显的脑损伤。受损结构包括额叶、颞叶、顶叶、岛叶和扣带回皮质；胼胝体；以及尾状核。CDT结果显示结构损伤程度最大。TMT-A测试显示与特定损伤部位有关，而TMT-B仅显示与孤立的损伤区域有关。
研究结果表明，纸笔认知测试与脑结构损伤有关，CDT值与损伤程度最大相关。特定的损伤部位可能与独特的测试相关，如TMT-A。应开发专门的测试，以指示特定区域的神经损伤。
