动脉瘤性蛛网膜下腔出血的临床诊疗决策

探讨动脉瘤性蛛网膜下腔出血的临床诊疗决策。运用循证医学对动脉瘤性蛛网膜下腔出血早期诊断,及时、合理、有效地选择个性化的治疗方案,降低动脉瘤性蛛网膜下腔出血的病残率和死亡率。     

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.     

Abnormal diurnal pattern of cortisol secretion in patients after aneurysmal subarachnoid hemorrhage

Substantial evidence suggests that impairment of the hypothalamus?pituitary system can occur following an aneurysmal subarachnoid hemorrhage (aSAH). Given that the diurnal cortisol rhythm is primarily controlled by the hypothalamus?pituitary system, this study examined whether changes in diurnal cortisol rhythm occurred after aSAH. Cortisol concentrations were measured in the saliva samples collected from patients after aSAH and other types of cerebral hemorrhage (non-aSAH) in the post-awakening period and at night (21:00?h), and the cortisol awakening response (CAR) and diurnal cortisol decline were determined. The area under the cortisol curve from immediately after to 45?min after awakening (CARauc) in the aSAH patient group was comparable to that in the non-aSAH or healthy control groups. However, an obvious cortisol peak was not found after the awakening period, and the morning/nighttime cortisol ratio in the aSAH patient group was significantly lower than that in other examined groups due to higher nighttime cortisol concentrations. In aSAH patients, the CARauc and nighttime cortisol concentrations were negatively correlated with the Fisher CT grade. These results indicate that the diurnal cortisol rhythm is not regulated normally after aSAH, and cortisol secretory activity decreases as the volume of subarachnoid bleeding increases. Our findings will be helpful to understand altered hypothalamus?pituitary?adrenal axis function after aSAH.     

自由基与蛛网膜下腔出血后脑血管痉挛的关系及防治策略

脑血管痉挛是蛛网膜下腔出血后的严重并发症之一,可引起脑组织严重缺血或迟发性缺血性脑损伤,甚至导致脑梗死,但其病理机制仍未完全清楚,而越来越多的研究表明自由基在脑血管痉挛病理变化过程中发挥着重要作用。通过对自由基与脑血管痉挛之间关系的科学分析,探讨蛛网膜下腔出血后与自由基相关的脑血管痉挛的防治策略。     

What differentiates declarative and procedural memories: reply to Cohen, Poldrack, and Eichenbaum (1997)

CPE claim that procedural and declarative representations differ on two important dimensions: flexibility and compositionality. I have proposed that the apparent flexibility of a memory depends entirely on the transfer conditions. Any retest is, in some sense, a test of flexibility, because something has changed since the original encoding episodic. I have argued that if one changes something that does not provide support to memory performance, the memory will appear flexible, and resistant to changes in the environment. If one changes the very thing that the representation codes, the memory will appear inflexible and easily disrupted by changes in the environment. This principle is equally true for procedural and declarative memory. CPE contend that procedural representations lack compositionality. An ideal test of this claim would examine the representation of a task that is widely agreed to be procedural (e.g. that has been demonstrated to be learned normally by amnesic patients, and in the absence of awareness by neurologically intact subjects). Such experiments appear not to have been conducted, and the fact is that many tasks that are widely agreed to be procedural probably are not compositional. They appear to be, as CPE contend, biases in a processing system; it is hard to imagine how repetition priming could be compositional. Nevertheless, this is not true of all procedural memories. There is a good deal of evidence that motor behaviour is organised hierarchically and has compositionality. There is every reason to think that most if not all motor behaviour is procedural; motor behaviour might be driven by goals that are declarative, but the low-level operations that actually manipulate effectors are closed to consciousness, do not depend on the medial temporal lobe or diencephalon, and would therefore be classified as procedural. CPE framed their theory of differences between procedural and declarative memory systems as an account of the deficit in amnesic patients. They therefore predict that the learning of amnesic patients should not show flexibility or compositionality. There is already at least one study showing learning in amnesic patients that is as flexible as that of control participants (Knowlton & Squire, 1996). There are not, to my knowledge, data on whether the motor skill learning of amnesic patients shows compositionality, but one might expect that it would, given that it does in neurologically intact participants, and given that motor skill learning appears unimpaired in amnesic patients. Thus, the conception of declarative and procedural memory provided by CPE may not provide a complete account of amnesic performance. The anatomic distinction between procedural and declarative memory systems appears quite strong, and there is therefore reason to believe that there are accompanying computational differences. There does not, however, appear to be sufficient evidence to support those differences proposed by CPE.     

Recognition memory for single items and for associations is similarly impaired following damage to the hippocampal region

The formation of new associations between items is critical for establishing episodic memories. It has been suggested that the hippocampus is essential for creating such associations but is not involved, or is much less involved, in memory for single items. In Experiment 1, we tested controls and amnesic patients with bilateral lesions thought to be limited primarily to the hippocampal region in both single-item and associative recognition memory tasks. In the single-item task, a conventional recognition memory task was administered in which participants studied either houses or faces and were tested for their ability to recognize the individual items. In the associative task, participants studied paired pictures of houses and faces with instructions that encouraged associating the two stimuli, and were tested for their ability to recognize the specific pairings that were presented at study. Like the controls, the amnesic patients performed more poorly on the associative task. Relative to the controls, the amnesic patients were impaired to a similar extent on the single-item and associative tasks. In Experiment 2, the performance of the amnesic patients was improved by increasing the number of presentations of the study lists (eight presentations instead of one). On both the single-item and associative tests, the performance of the amnesic patients after eight presentations was now identical to the performance of the controls who had been given only one presentation of the study list. Thus, the associative condition was not disproportionally difficult for the amnesic patients. These results are consistent with the idea that the hippocampus is similarly involved in single-item and associative memory.     

遗忘症患者外显与内隐记忆分离的实验研究：自由回忆与再认任务

采用WMS－CR和MMSE筛选了9名遗忘症患者,采用自由回忆和再认两项任务观察了他们及正常对照组的外显记忆。结果发现：遗忘症患者两项外显记忆任务操作呈分离现象,自由回忆任务操作明显受损,再认任务的操作尽管较对照组低,但与对照组差异未达显著性水平。推论;①外显记忆受患者损伤的颞叶或间脑结构调节。②再认任务至少包含两种性质不同的潜在加工过程,一种为意识性重组加工,另一种为无意识自动加工,两者相互独立地贡献再认任务的操作。正常人意识性重组加工的贡献占优势,掩盖了无意识的作用。遗忘症患者意识性重组加工损伤,无意识自动加工部分代偿作用。③先前研究未对遗忘症患者进行认知功能的筛选,患者对再认障碍可能源于其他认知功能障碍,而非记忆障碍之故。     

Remote memory in a patient with circumscribed amnesia

It has been suggested that extensive and severe remote memory loss is not a component of a circumscribed amnesic syndrome but may be attributable to problem solving and retrieval deficiencies associated with the frontal lobe damage which is present in some amnesic patients. In order to assess this notion, retrograde amnesia was studied in a patient, W.H., who had no apparent cortical damage revealed by radiological examination, and who evidenced no major cognitive deficiency other than amnesia. Regardless of whether remote memory was measured by recall or recognition procedures, patient W.H. exhibited impaired memory for information from the 1960s, 1970s, and 1980s, but was unimpaired in retrieving information from the 1940s and 1950s. These results demonstrate that retrograde amnesia can occur in patients who have a circumscribed memory deficit.     

On the contribution of perceptual fluency and priming to recognition memory

Repetition priming has been shown to be independent of recognition memory. Thus, the severely amnesic patient E.P. has demonstrated intact stem completion priming and perceptual identification priming, despite at-chance performance on recognition memory tasks. It has also been shown that perceptual fluency can influence feelings of familiarity, in the sense that items perceived more quickly tend to be identified as familiar. If studied items are identified more fluently, due to perceptual priming, and fluency leads to familiarity, why do severely amnesic patients perform no better than chance on recognition memory tasks? One possibility is that severely amnesic patients do not exhibit normal fluency. Another possibility is that fluency is not a sufficiently strong cue for familiarity. In two experiments, 2 severely amnesic patients, 3 moderately amnesic patients, and 8 controls saw words slowly clearing from a mask. The participants identified each word as quickly as possible and then made a recognition (old/new) judgment. All the participants exhibited fluency, in that old responses were associated with shorter identification times than new responses were. In addition, for the severely amnesic patients, priming was intact, and recognition memory performance was at chance. We next calculated how much priming and fluency should elevate the probability of accurate recognition. The tendency to identify studied words rapidly (.6) and the tendency to label these rapidly identified words old (.6) would result in 36% of the studied words being labeled old. Other studied words were identified slowly (.4) but were still labeled old (.4), resulting in an additional 16% of studied words labeled old. Thus, the presence of fluency increases the probability of accurate recognition judgments to only 52% (chance = 50%). This finding explains why amnesic patients can exhibit both priming and fluency yet still perform at chance on recognition tests.     

IMPLICIT MEMORY IN AMNESIC PATIENTS:

Abstract— Previous observations of spared priming in amnesic patients have been based almost entirely on data from visual implicit memory tests Our research examined perceptual priming.in amnesic patients and control subjects on an auditory identification task in which previously spoken words and new words were presented in white noise We manipulated type of encoding task (semantic vs nonsemantic) and speaker's voice at study and test (same vs different) Priming was little affected.by either manipulation, and amnesic patients exhibited normal priming in all experimental conditions On an explicit test of recognition memory, by contrast, amnesic patients exhibited.severely impaired performance following the semantic study task, all subjects showed poor explicit memory following the nonsemantic study task Results are consistent with the idea that auditory priming depends largely on a presemantic auditory perceptual representation system     

Impaired priming of new associations in amnesia

We assessed priming of new associations in amnesic patients and healthy control subjects in a paradigm developed by Graf and Schacter (1985). Subjects were presented unrelated word pairs embedded in sentences (e.g., A BELL was hanging over the baby's CRADLE) and were asked to rate how well the sentences related the two words. Subjects were then given a word completion test. They were shown three-letter word stems and were asked to complete the stem with the first word that came to mind. In the same context condition, each word stem was presented together with the word that had appeared in the same sentence during study (e.g., BELL-CRA--). In the different context condition, each stem was presented together with a new word that had never been presented (e.g., APPLE-CRA--). Control subjects completed more words in the same context condition than in the different context condition. In contrast, amnesic patients did not complete any more words in the same context condition than in the different context condition. Indeed, across two experiments none of the amnesic patients exhibited consistent priming of new associations. Thus, although amnesic patients do exhibit entirely normal priming of preexisting memory representations, they do not appear to exhibit priming of new associations in this paradigm.     

Paired-associate learning and priming effects in amnesia: a neuropsychological study

Despite severe deficits of recall and recognition, amnesic patients can exhibit normal priming effects. Amnesic patients have also been reported to perform well on tests of paired-associate learning that involve related word pairs (e.g., table-chair). The present study investigated the role of priming effects in paired-associate learning. Experiment 1 illustrated the distinction between the memory impairment of amnesic patients and their intact priming ability. Amnesic patients were markedly deficient in learning unrelated word pairs, despite exhibiting normal priming as measured by a word-completion test involving the same words. In Experiment 2A, amnesic patients showed good paired-associate learning for related word pairs, though control subjects still performed significantly better. In addition, the good performance by amnesic patients was short-lived, and performance fell to baseline after a 2-hr delay. Control subjects performed well above baseline at all delay conditions. Experiment 2B showed that the forgetting of related word pairs by amnesic patients followed the same time course as the decay of word priming. Experiment 3 showed that amnesic patients were as good as control subjects at learning related word pairs when incidental learning and test procedures were used (a word-association test). The advantage of control subjects over amnesic patients in Experiments 2A and 2B could therefore be attributed to the explicit learning instructions that are standard in paired-associate tests. Finally, Experiment 4 showed that amnesic patients exhibited normal priming when they were asked to "free associate" to words (e.g., child) that were semantically related to previously presented words (e.g., baby). The results indicate that both priming effects and paired-associate learning of related word pairs depend on activation, a process that is preserved in amnesia. Activation can account for the findings of good performance by amnesic patients on tests of word priming (Experiments 1 and 2B), related paired associates (Experiments 2A and 2B), and word association (Experiments 3 and 4). Activation is a transient phenomenon presumed to operate on and facilitate access to preexisting representations. Control subjects can establish new associations and can strengthen preexisting associations by engaging processes that are impaired in amnesia. As a result, when explicit learning instructions are used to test paired-associate learning of related word pairs, control subjects can learn better and can remember longer than can amnesic patients (Experiments 2A and 2B).(ABSTRACT TRUNCATED AT 400 WORDS)     

Distinguishing states of awareness from confidence during retrieval: evidence from amnesia

Two experiments were conducted to determine whether recollective experience is distinguishable from confidence. In Experiment 1, we tested college participants in a within-subjects design and replicated Gardiner and Java's (1990) findings from a between-subjects design. We observed higher remember judgments for words than for nonwords, but higher know judgments for nonwords than for words. For confidence judgments, we obtained greater sure than unsure responses for both words and nonwords. In Experiment 2, we tested amnesic participants and matched control participants. Control participants produced the same pattern of results as college participants, but the results of amnesic participants diverged in an important way. For confidence judgments, the amnesic participants, like the control and college participants, made more sure than unsure judgments to both words and nonwords. But for recollective judgments, amnesic participants did not produce the crossover interaction for words and nonwords. This striking difference between the performance of memory-intact and amnesic participants demonstrates that recollective judgments and confidence that accompany retrieval are not isomorphic psychological experiences.     

No evidence of risk-taking or impulsive behaviour in a person with episodic amnesia: Implications for the role of the hippocampus in future-regarding decision-making

Does advantageous decision-making require one to explicitly remember the outcome of a series of past decisions or to imagine future personal consequences of one's choices? Findings that amnesic people with hippocampal damage cannot form a clear preference for advantageous decks over many learning trials on the Iowa Gambling Task (IGT) have been taken to suggest that complex decision-making on the IGT depends on declarative (episodic) memory and hippocampal integrity. Alternatively, impaired IGT performance in amnesic individuals could be secondary to risk-taking and/or impulsive behaviour resulting from impaired episodic future thinking (i.e. prospection) known to accompany amnesia. We tested this possibility in the amnesic individual K.C. using the IGT and the Toronto Gambling Task (TGT), a novel task that dissociates impulsivity from risk-taking without placing demands on declarative memory. K.C. did not develop a preference for advantageous over disadvantageous decks on the IGT and, instead, showed a slight preference for short-term gains and an inability to acquire a more adaptive appreciation of longer-term losses. He also did not display impulsive or risk-taking behaviour on the TGT, despite a profound inability to imagine personal future experiences. These findings suggest that impaired decision-making on the IGT in amnesia is unlikely to reflect a predilection to act in the moment or failure to take future consequences into account. Instead, some forms of future-regarding decision-making may be dissociable, with performance on tasks relying on declarative learning or on episodic-constructive processes more likely to be impaired.     

Influence of prior events on cognitive judgments in amnesia.

Amnesic patients and control Ss read the names of famous and nonfamous persons. Subsequently, both groups were more likely to designate a name as famous if it had been encountered previously. The facilitatory effect of prior presentation was similar for amnesic patients and control Ss and similar for famous and nonfamous names. For amnesic patients, the effect occurred despite severely impaired recognition memory for the names. In a 2nd experiment, recombining the first and last names that had been presented together did not diminish the facilitatory effect of prior presentation, which indicates that the effect does not depend on forming an association between first and last names. The results show that nondeclarative (implicit) memory can support the acquisition of information that is specific (e.g., names of persons) and that has no preexisting representation (e.g., nonfamous names).     

Just lying there, remembering: improving recall of prose in amnesic patients with mild cognitive impairment by minimising interference

The hallmark of amnesia is poor explicit long-term memory along with normal short-term memory. It is often stated that information encountered by amnesic patients is forgotten within 1 minute of presentation. However, previous work has not distinguished between forgetting as a function of time versus the interfering material occupying that time. We show that there is a marked benefit of reduced interference in amnesic patients with mild cognitive impairment (MCI), a condition that is characterised by anterograde amnesia in the absence of other neuropsychological deficits and carries an increased risk for Alzheimer's disease. The result suggests that long-term memory is encoded in these patients to a greater extent than had been realised but that their memory is highly vulnerable to interference.     

Surgery of aneurysms of the cerebral arteries--results and problems

Surgery has been performed on 100 intracranial aneurysms during the past seven years. Of these, 96 involved the application of microsurgical techniques and could definitely be clipped. Lethality was 8%. Post-surgical deterioration of the clinical neurological status was observed in another 20 patients, but vanished subsequently in 16 of them. Immediate surgery within 48 hours of the subarachnoidal hemorrhage is recommended to avoid subsequent hemorrhage and prevent severe vasospasmic phenomena. Only patients whose general status is good (Hunt and Hess degree 1 or 2) are suitable for immediate surgery.     

Somatic and autonomic indexes of recovery from electroconvulsive shock-induced amnesia in rats

Autonomic response indexes of experimental amnesia have recently been found to have higher electroconvulsive shock (ECS) intensity thresholds and steeper retrograde gradients than have traditional somatic indexes. The present studies examined the hypothesis that recovery from somatically indexed experimental amnesia depends upon the existence of autonomically available residual memory. In a between-subjects design, a 200-mA ECS was used to produce amnesia for a tone-footshock pairing as indicated by lick suppression, defection, and bradycardia. The next day, these amnesic animals received a reminder footshock outside of the training apparatus, which was found to restore memory on a test trial 24 hr later. The behavior of control groups indicated that this reminder effect was due to the restoration of specific memory rather than systemic consequences of treatment. With a within-subjects design, a second experiment obtained a reminder effect in animals individually shown to be "fully" amnesic by all three response indexes monitored. A third experiment varied the intensity of the reminder footshock and revealed that the different memory indexes examined do not have reminder-footshock thresholds inversely related to their initial resistance to amnesia. The results support a retrieval-failure view of experimental amnesia and suggest that the same fundamental physiological processes underlie both autonomically indexed memory and somatically indexed memory.     

The information that amnesic patients do not forget

The performance of three kinds of amnesic patients and control subjects was assessed using four methods for testing memory: free recall, recognition, cued recall, and word completion. Whereas amnesic patients were impaired on free recall, recognition, and cued recall, they were normal on word completion. Moreover, performance on the word-completion test declined at a normal rate reaching chance after about 120 min. The word-completion test resembled the cued-recall test in that the initial letters of previously presented words were given as cues. It differed from cued recall only in the instructions, which directed subjects away from the memory aspects of the test and asked them to complete each three-letter cue with the first word that came to mind. The present results offer an explanation of conflicting findings that have been obtained with amnesic patients on tests of the cued-recall type. The results are considered in terms of a process (activation or procedural learning), which is spared in amnesia and not dependent on the integrity of the damaged brain regions.     

Amnesic effect of cycloheximide in the mouse mediated by adrenocortical hormones.

The involvement of adrenocortical hormones in the amnesic effect of cycloheximide was examined in mice. Subcutaneous injection of cycloheximide shortly before a training trial of a passive avoidance task resulted in an amnesia of the avoidance response. However, amnesia was absent in the adrenalectomized animals in which cerebral protein synthesis was suppressed by cycloheximide. Injection of corticosteroids antagonized the amnesic effect, most effecively if the steroids were given immediately after training. The influence of the hormonal treatments upon the amnesic effect was not ascribable to a change in general activity level. The amnesic effect of subcutaneously injected cycloheximide appears to be mediated by hormonal deficiency, and not related to suppression of the cerebral protein synthesis.