目的 探讨抽动秽语综合征(TS)患儿联想学习能力和视觉感知的变化,为调查TS儿童工作记忆和视觉感知受损机制提供基础。方法 选择2021年1月—2024年1月期间在重庆医科大学附属大足医院儿科确诊为TS的儿童75例。根据是否合并注意缺陷多动障碍(ADHD)、强迫障碍(OCD)/强迫行为(OCB),分为3个亚组:单纯TS组(n=37)、TS+ADHD组(n=17)、TS+OCD/OCB(n=21)。另外选择75例健康儿童为对照组。通过罗格斯大学获得等效性测试(RAET)评估受试者联想学习能力,记录习得试验次数(NAT)、习得错误率(ALER)、检索错误率(RER)、概括错误率(GER)。通过剑桥自动化成套神经心理测试(CANTAB)评估受试者空间工作记忆(SWM)。通过视觉运动整合发育测试(BEERY VMI)评估受试者视觉运动整合、视觉感知和运动协调能力。结果 TS组NAT、ALER和CANTAB总错误次数显著高于对照组(Z=3.744、4.011、7.073,P＜0.001),视觉运动整合评分、视觉感知评分、运动协调评分显著低于对照组(Z=6.272、4.613、3.608,P＜0.001);但两组RER和GER比较差异无统计学意义(P＞0.05)。与对照组相比,TS 3个亚组的NAT、ALER、CANTAB总错误次数显著升高(P＜0.05),而视觉运动整合、视觉感知和运动协调评分显著下降(P＜0.05)。经Spearman秩相关性分析,TS患者CANTAB总错误次数与VMI视觉感知评分、运动协调评分(r=-0.330、-0.293,P<0.05)呈显著负相关。结论 TS患儿与基底神经节相关的联想习得阶段学习能力、视觉感知和SWM能力受损,而主要与海马体相关的联想测试检索阶段和概括阶段学习能力并未受到影响。
Abstract
Objective To investigate alterations in associative learning and visual perception in children with Tourette syndrome (TS), in order to provide foundational insights into the mechanisms underlying working memory and visual processing impairments in this population. Methods A total of 75 TS children in the pediatrics department of Dazu Hospital Affiliated to Chongqing Medical University from January 2021 to January 2024 were selected as the study subjects.The participants were stratified into three subgroups based on comorbidity profiles: Sample TS (n=37), TS with comorbid attention-deficit/hyperactivity disorder (TS+ADHD, n=17), and TS with comorbid obsessive-compulsive disorder/obsessive-compulsive behavior (TS+OCD/OCB, n=21).Seventy-five healthy children served as controls.The participants′ associative learning ability was assessed by the Rutgers Acquired Equivalence Test (RAET), and the number of acquisition trials (NAT), acquisition learning error ratio (ALER), retrieval error rate (RER), and generalization error rate (GER) were recorded.Other cognitive assessments included Cambridge Neuropsychological Test Automated Battery (CANTAB) evaluating spatial working memory (SWM),Beery Visual-Motor Integration (Beery VMI) assessing visual-motor integration, visual perception, and motor coordination. Results Compared with controls, TS children showed significantly increased NAT, ALER, and CANTAB total errors (Z=3.744, 4.011, 7.073, P<0.001), reduced visual motor integration score, visual perception score and motion coordination score (Z=6.272, 4.613, 3.608, P<0.001).No significant differences were observed in RER or GER (P>0.05).Compared with the control group, the total number of NAT, ALER and CANTAB errors in TS subgroups was significantly increased (P<0.05), while visual motor integration, visual perception and motion coordination score were significantly decreased (P<0.05).Negative correlations existed between CANTAB errors and VMI visual perception/motor coordination scores in TS children.(r=-0.330, -0.293, P<0.05). Conclusion TS children exhibit impaired associative learning during acquisition (basal ganglia-dependent phase) alongside visual perception and SWM deficits, while hippocampal-dependent retrieval/generalization phases remain intact.
关键词
抽动秽语综合征 /
联想学习 /
空间工作记忆 /
视觉感知 /
儿童
Key words
Tourette syndrome /
associative learning /
spatial working memory /
visual perception /
children
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基金
重庆市科卫联合医学科研项目(DZKJ2022JSVJ-KWXM1038)
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