汉语母语孤独症谱系障碍“日历计算专家”认知加工特征与脑机制分析  

A Pilot Study on Cognitive Processing Characteristics and Cerebral Mechanisms of Native Chinese-Speaking Savant Calendar Calculators with Autism Spectrum Disorder

作　　者：陈健 徐曙天 邬钰玮 陈松美 单春雷 CHEN Jian;XU Shutian;WU Yuwei;CHEN Songmei;SHAN Chunei(Community Health Service Center of Tianlin Street,Shanghai 200233,China;School of Rehabilitation Science,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Shanghai No.3 Rehabilitation Hospital,Shanghai 200436,China;Institute of Rehabilitation,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Tong Ren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海市徐汇区田林街道社区卫生服务中心,上海200233 [2]上海中医药大学康复医学院,上海201203 [3]上海中医药大学附属岳阳中西医结合医院,上海200437 [4]上海市第三康复医院,上海200436 [5]上海交通大学医学院康复研究院,上海200025 [6]上海交通大学医学院附属同仁医院,上海200336

出　　处：《康复学报》2024年第2期161-166,共6页Rehabilitation Medicine

基　　金：国家自然科学基金项目(82272612);上海康复医学临床医学研究中心项目(21MC1930200)。

摘　　要：目的 分析汉语母语孤独症谱系障碍(ASD)“日历计算专家”(SCC)认知加工特征,并结合头颅磁共振成像(MRI)分析相关脑机制。方法 对1例具有SCC特征的汉语母语ASD患者进行随机正常日历计算测试、调整新日历强记能力测试、数字计算能力测试、线方向判断(JLO)测试、失用症检查(口面失用、言语失用和意念运动性失用检查)、额叶功能(FAB)测试和蒙特利尔认知功能评估(MoCA)。采用MRI头颅检查SCC患者,并与健康受试者比较,探讨其脑器质性损伤情况。结果 (1)日历计算能力测试:SCC患者“随机正常日历计算”正确率为80%,平均每题答题时间11.8 s,而健康受试者“随机正常日历计算”平均正确率仅为16%。(2)日历强记能力测试:SCC患者“调整新日历计算”正确率仅为20%。(3)数字计算能力:SCC患者加法和除法计算正确率均为100%,平均耗时分别为10.67 s和58.19 s;减法和乘法计算正确率均为93.8%,平均耗时分别23.51 s和34.88 s。(4) JLO测试:SCC患者JLO测试得分为27分。(5)失用症检查:部分口面失用,言语失用检查基本正常,但存在意念运动性失用(得分32分)。(6) FAB和MoCA评分:SCC患者FAB评分13分,主要表现为相似性测验和言语流畅度等方面功能受损。MoCA评分17分,主要表现为认知功能障碍,抽象、语言功能缺失明显。(7) MRI检查:与健康受试者比较,SCC患者左侧颞叶前方蛛网膜囊肿,两侧海马体积小,以左侧更为明显,左侧顶枕叶皮质萎缩伴皮质下白质胶质增生。结论 该汉语母语孤独症谱系障碍存在“日历计算专家”能力,除视空间能力较好外,额叶功能、左顶叶功能(数字计算能力降低、意念运动性失用)均受损;“日历计算专家”能力可能与左侧颞叶蛛网膜囊肿后右侧顶叶的功能性代偿有关。Objective To analyze the cognitive processing characteristics of a native Chinese-speaking savant calendar calculator(SCC)with autism spectrum disorder(ASD)and to investigate the related brain mechanisms with cranial magnetic resonance imaging(MRI).Methods One native Chinese-speaking ASD patient with SCC features was assessed with the randomized calendar calculation test,the adjusted new calendar memory ability test,the numerical calculation ability test,the judgement of line orientation(JLO)test,the apraxia examination(orofacial apraxia,speech apraxia,and ideomotor apraxia examination),the frontal assessment battery(FAB),and the Montreal cognitive assessment(MoCA).The patient with SCC was examined with crainial MRI and compared with healthy subjects to explore the organic brain damage.Results(1)Calendar calculation ability test:the correct rate of random normal calendar calculation in the SCC patient was 80%,and the average time of answering each question was 11.8 s,while the average correct rate of random normal calendar calculation in the healthy subjects was only 16%.(2)Calendar memorizing ability test:the correct rate of the adjusted new calendar calculation in the SCC patient was only 20%.(3)Numerical calculation ability:the correct rate of addition and division in the SCC patient was 100%,and the average time was 10.67 s and 58.19 s respectively.The correct rate of subtraction and multiplication was 93.8%,and the average time was 23.51 s and 34.88 s,respectively.(4)JLO test:the score of JLO test in the SCC patient was 27.(5)Examination of apraxia:the patient showed partial orofacial apraxia and no speech apraxia,but the patient had ideomotor aphasia(score=32).(6)Scores of FAB and MoCA:the FAB score of the patient was 13,and mainly indicated impairment in similarity test and verbal fluency.The MoCA score was 17,mainly characterized as cognitive dysfunction and obvious abstract and language function loss.(7)MRI examination:compared with the healthy subjects,the SCC patient had arachnoid cysts in the left ant

关 键 词：孤独症谱系障碍 学者综合征 日历计算专家 认知功能 脑机制 

分 类 号：R749.94[医药卫生—神经病学与精神病学]