【作者】 张银玲；

【导师】 皇甫恩； 苗丹民；

【作者基本信息】 第四军医大学 ， 应用心理学， 2002， 硕士

【摘要】 认知包括感觉、知觉、记忆、思维、判断、推理、语言等。本研究采用认知侧化成套测验评估脑肿瘤病人认知功能障碍的特点，以探讨脑结构与心理功能的关系。 本课题采用修订后的美国神经心理学家H.W.Gordon编制的认知分化成套测验，本测验由两套测验材料组成，一套为视觉-空间能力测验，包括定位测验、三维旋转测验、图画完形和积木连接四个分测验，用来评价个体或群体空间认知能力水平；另一套为语言-序贯能力测验，分别由系列声音、系列数字、偏旁组字和类别组词四个分测验构成，以此测验成绩衡量个体或群体的语言能力。本测验除了得出八项分测验的成绩之外，在此基础上还可获得两组类型指标及认知侧化商数：(1)空间能力分数A，其值等于四项空间认知测验成绩的均值；(2) 语言-序贯能力分数P，其值等于四项语言-序贯能力测验成绩的均值；(3) 认知功能侧化商数CLQ，为两个复合分数之差，即CLQ=A-P；当CLQ小于零时，表明被试的认知功能特点倾向于以言语认知为主要特征；当CLQ大于零时，表明被试的认知功能特点倾向于以空间认知为主要特征。 本课题共分两部分。 第一部分为右侧脑肿瘤患者认知侧化功能特征的研究采用修订版认知分化成套测验，对26例右侧大脑肿瘤患者及26例正 第四军医大学颀士学位论文 常对照进行研究，病例入组标准为：成人门8币0岁）：无意识障碍，无 失语或明显的视觉障碍，无高血压、糖尿病等疾病，均经CT或MRJ检 查，颅内占位效应明显，手术治疗诊断明确，肿瘤大小 7－224cm＼ 均为 右利手。测试于术前一周左右进行，测查时患者无明显头痛症状，能合作。 正常对照组的年龄性别及文化程度与实验组相匹配，均为右利手。结果： 实验组四项空间认知能力测验成绩即三维旋转测验、图画完形测验、积木 连接测验和定位测验均明显低于对照组（P（．05），实验组与对照组的A 分数分别为94．gi和104．40；四项语言－序贯能力测验成绩中系列声音测验 成绩明显低于对照组叩O刀5＼系列数字测验、偏旁组字测验和类别组词 测验成绩与对照组无明显差异（P）0刀5），实验组与对照组的 P分数分别 为 95．56和 10230。实验组与对照组的认知功能侧化商数 CLQ为l．65和 2．10。结论：实验组的空间认知能力明显低于对照组，说明右侧大脑脑肿 瘤由干其周围脑水肿及肿瘤侵及周围脑实质造成脑实质损伤会影响人的 空间认知功能；系列声音测验成绩的差异的原因是因为该测验涉及到听、 写、注意、记忆等多种任务，对复杂的任务是由双脑协同来完成的。另外， 声音为非语言材料，声音传入大脑后先经右半球形成发出该声音物体的图 像并进行综合，再通过脐服体传入左半球进行抽象、分析，最后形成发出 该声音物体的名称概念并正确写出。但由于实验组右半球肿瘤造成一定程 度的脑损害，故结果差异。其它三项分测验成绩无明显差异，说明实验组 和对照组左半球信息加工能力基本一致。P值的差异是由系列声音的差异 引起的。实验组CLQ为刁石5，说明实验组语言认知能力基本正常。结论 说明大脑右半球与空间认知能力有关，脑肿瘤患者的空间认知能力较正常 人有一定程度的下降。 第二部分，左侧脑肿瘤患者认知侧化功能特征的研究 采用修订版认知分化成套测验对 31例左侧叶脑肿瘤患者和 55例正常 3 第四军医大学硕士学位论文人进行测试，病例组和正常对照组的入组标准同上。结果：两组被试四项言语－序贯能力测验成绩均有明显差异，表现为病例组明显低于对照组（P＜0刀5），四项视觉－空间认知能力测验成绩未构成显著差异（P＞0．05）。实验组与对照组 P值有明显差异，分别为 89刀7和 106．17；实验组与对照组的A值试验结果未构成显著差异，分别为98．76和100．71。实验组与对照组认知侧化商数CLQ分别为9厂0和5．46。结论：实验组的言语－序贯能力成绩明显低于对照组，说明与对照组相比，实验组言语－序贯能力方面存在障碍，而两组被试四项视觉－空间认知能力成绩未构成显著差异，实验组的认知侧化商数为9．70，正值说明相对于对照组来说，实验组空间认知能力基本正常，以右半球信息加工模式为主。 本研究通过比较、分析脑肿瘤患者和正常人言语－序贯能力测验和视觉－空间认知能力测验的成绩，探讨了左侧叶大脑肿瘤患者言语．序贯能力的特征和右侧大脑肿瘤患者视觉空．间认知能力的特征。结果表明，左侧大脑肿瘤患者言语－序贯能力受到影响；右侧大脑肿瘤患者空间认知能力受到影响。但肿瘤大小、性质、病程长短等对各项作业成绩的影响需要进更多还原

【Abstract】 Cognitive feature is characteristics of psychological activities. In this paper, we investigated the cognitive disorders on patients suffering from cerebral tumor with the Cognitive Laterality Battery (CLB), and explored the relationship between the structure and psychological function of the brain.In this study the revised CLB, designed by H.W.Gordon, American neuropsychologist, are used as instrument. CLB includes two parts. One is about the tests on the visuospatial factors, composed with localization, orientation, form completion and touching blocks, which used to evaluate the level of cognitive abilities of individuals and groups. The other is about the tests on verbal-sequential factors, composed with serial sounds, serial numbers, word production (letter) and word production (categories). With the test scores, the language abilities of individuals and groups are judged. On the basis of eight sub-tests’ scores, the synthetic index is obtained: ﹕cores A of the eigenvalues of the visuospatial factors, the value is equal to the average of the scores of the four eigenvalues of the visuospatial tests, ﹕cores P of the eigenvalues of the verbal-sequential factors, the value is the average of the scores of the four eigenvalues of the verbal-sequential tests. (3)CLQ, cognitive laterality quotient, is the remainder of the above scores(A and P), ie, CLQ=A-P.That CLQ is below zero showed that the principal characteristic of the subject’s cognitive feature tends to language cognition. When above zero, shows that the main characteristic tends to spatial cognition.This paper comprises two parts. Part 1: study of the cognitive disorder on cases with right cerebral tumor. A case control study was carried out, based on 26 patients with right cerebral tumor and 26 matched healthy people. The case entering standard: adults, aged from 18 to 60, without consciousness disorder, aphasia, obvious sight disorder, without such diseases as hypertension and diabetes and so on. The results of CT and MRI showed that there are obvious localizations and confirmed by surgery. The tests were performed a week before surgery. The patients are cooperative and have not apparent headache, when the tests are being performed. The age, sex and literacy level of the control groups are matched with those of cases. They are all right-handness. Result: the four scores of localization, orientation form completion and touching blocks of the test groups are all lower than those of the control groups(P < 0.05). The A values are 94.91 and 104.40, respectively. Among the four scores of the eigenvalues of the verbal-sequential factors, the score of serial sounds of the test group is significantly lower than that of the control group(P < 0.05). the difference between other scores such as serial numbers, word production (letter) and word production (categories) of the test group and the control group is not significant(P > 0.05). The P values are 95.56 and 102.30, respectively. The CLQ value of the test group is -1.65. Conclusion: The eigenvalues of the visuospatial factors of the test group are significantly lower that that of the control group. It shows that the brain damage causes by right cerebral tumor will influence spatial skills of human beings. The test ofserial sounds, which is the sub-test of verbal-sequential skills, involves many tasks, including audition, writing, attention and memory and so on. The complex task was done in coordination with both cerebral hemispheres. In addition, the sound, as non-verbal material, firstly goes into brain, formed and synthesized by right hemisphere, then goes through coordinative fiber to left hemisphere and is abstracted and analyzed by left hemisphere, eventually, the notion of the objective which givers out the sound is formed and written correctly. In our study, the patients of test group suffer from right cerebral hemisphere tumors, which impair the brain. So the scores of serial sounds of test group are different significantly from that of control group. While the other three scores are n更多还原