Davies K G, Bell B D, Bush A J, Wyler A R
Epi-Care Center, Baptist Memorial Hospital, Department of Neurosurgery, University of Tennessee, Memphis 38103, USA.
Epilepsia. 1998 Aug;39(8):820-8. doi: 10.1111/j.1528-1157.1998.tb01175.x.
Decreased memory function represents the area of greatest neuropsychological morbidity after anterior temporal lobectomy (ATL), particularly for left ATL candidates. We wished to identify easily derived demographic and neuropsychological predictors of risk of pre- to postoperative memory decline using only information available preoperatively.
We assessed decline in memory as measured by the California Verbal Learning Test (CVLT) by deriving multiple regression equations using the following measures as independent variables: age at onset, chronological age at time of surgery, sex, Full Scale IQ (FSIQ), level of education, and preoperative memory scores. In all, 203 patients (93 males, 110 females), undergoing ATL (107 left, 96 right) with preoperative and 6-month postoperative testing, were examined.
The combination of age, FSIQ, sex, side of surgery and preoperative score was highly predictive (p-values < 0.0001) of postoperative memory scores. Higher postoperative scores were associated with higher preoperative score, younger chronological age, higher FSIQ, female sex, and right side of resection. Reliable change index (RCI) values were used to estimate meaningful decline on the total score across five trials. Logistic regression analysis showed preoperative score and age to be predictors of RCI decline for left-sided resections. Sensitivity of decline (> or =90th centile RCI) prediction was 56%, and specificity was 95%. Validation in 30 patients from a separate population of patients undergoing left ATL produced similar figures.
The derived regression equations can accurately predict verbal memory decline on a list-learning task in approximately 50% of individual patients undergoing ATL, and false-positive prediction errors are very rare.
记忆功能减退是颞叶前部切除术（ATL）后神经心理学发病率最高的领域，尤其是对于左侧ATL的患者。我们希望仅使用术前可用信息来确定术前至术后记忆下降风险的易于获得的人口统计学和神经心理学预测因素。
我们通过使用以下测量值作为自变量推导多元回归方程，来评估加利福尼亚言语学习测试（CVLT）所测量的记忆减退：发病年龄、手术时的实际年龄、性别、全量表智商（FSIQ）、教育水平和术前记忆分数。总共检查了203例接受ATL（107例左侧，96例右侧）的患者（93例男性，110例女性），这些患者术前和术后6个月均接受了测试。
年龄、FSIQ、性别、手术侧别和术前分数的组合对术后记忆分数具有高度预测性（p值<0.0001）。术后分数较高与术前分数较高、实际年龄较小、FSIQ较高、女性性别和右侧切除有关。可靠变化指数（RCI）值用于估计五次试验中总分的有意义下降。逻辑回归分析显示，术前分数和年龄是左侧切除术后RCI下降的预测因素。下降（>或=第90百分位数RCI）预测的敏感性为56%，特异性为95%。在另一组接受左侧ATL的患者中对30例患者进行验证得到了类似的数据。
推导得出的回归方程可以准确预测约50%接受ATL的个体患者在列表学习任务中的言语记忆下降情况，且假阳性预测错误非常罕见。
