慢性疼痛认知异常的脑电图功率谱评估*

Evaluation of cognitive impairment associated with chronic pain by electroencephalogram power spectrum ratio à

摘要:

目的：分析慢性疼痛认知异常患者的脑电图功率谱特征及与蒙特利尔认知功能评估量表的相关性。方法：本研究选取2022年6月至2023年6月连续在深圳市人民医院疼痛科就诊的慢性疼痛患者及招募的健康受试者,共筛选278例慢性疼痛受试者,其中参与试验全部过程并完成脑电图检查者124例；健康受试者8例。采集蒙特利尔认知功能评分和静息态脑电图,按照年龄、性别、疼痛部位、受教育年限、抑郁症筛查量表PHQ-9进行匹配。按照认知功能评分等级分为慢性疼痛认知异常组 ( A组,n=8 )、慢性疼痛认知正常组 ( B组,n=8 )和健康对照组 ( C组,n=8 ),并对各组患者或健康受试者的认知功能和各脑区功率谱差异及二者之间的相关性进行分析。结果：慢性疼痛认知异常组患者语言能力 [ 2.00 (0.75 ) vs 3.00 ( 0.00 )]和延迟记忆力[1.00 ( 1.75 ) vs 4.50 ( 2.00 ) ]较认知正常组降低,视空间与执行能力[ 3.00 (1.75 ) vs 5.00 ( 0.00 ) ]、计算力[ 2.00 ( 2.00 ) vs 3.00 ( 0.00 )]、语言能力[ 2.00 (0.75 ) vs 3.00 ( 0.00 )]、延迟记忆力[ 1.00 ( 1.75 ) vs 4.00 (1.75 )]较健康对照组降低,差异有统计学意义 ( P < 0.05 )；慢性疼痛认知异常组额叶、中央区、颞叶、顶叶、枕叶脑电图功率频谱比值均高于认知正常组和健康对照组[ 3.68 ± 1.63 vs 1.66 ± 0.93 vs 0.47 ± 0.38; 2.13 ( 1.21 ) vs 0.47 ( 0.74 ) vs 0.19 ( 0.16 ); 1.82 ( 1.10 ) vs 0.85 ( 0.70 ) vs 0.29 ( 0.29 ); 1.64 ( 0.89 ) vs 0.59 ( 0.51 ) vs 0.20 ( 0.05 ); 0.83 ( 0.61 ) vs 0.38 ( 0.35 ) vs 0.11 ( 0.09 )],差异有统计学意义 ( P < 0.05 )；慢性疼痛认知异常患者语言能力与中央区、颞叶、顶叶功率谱比值呈负相关,( r = -0.760、-0.756、-0.756,P < 0.05 )。结论：慢性疼痛认知异常患者以语言能力和延迟记忆力下降为特征,且语言能力和中央区、颞叶、顶叶功率谱比值呈负相关,提示脑电图功率谱作为慢性疼痛认知异常早期识别的定量生物标志物具有一定的临床意义。

Abstract:

Objective: To analyze the characteristics of electroencephalogram power spectrum ratio and its correlation with Montreal Cognitive Assessment (MoCA) in patients with cognitive impairment of Chronic pain. Methods: Patients with chronic pain and healthy participants recruited in Department of Pain Medicine, Shenzhen People"s Hospital from June 2022 to June 2023 were assessed by MoCA and resting-state electroencephalography (rsEEG). A total of 278 participants with chronic pain were screened, of which 124 participated in the whole process of the trial and completed Electroencephalography examination, and 8 healthy participants. Three groups matched by age, gender, education years, pain site, and PHQ-9 and they were groups of chronic pain with cognitive impairment ( A, n=8 ), chronic pain with cognitive normal ( B, n=8 ), and health control ( C, n=8 ). We analyzed and compared the correlations and differences of MoCA and power spectrum ratio between cognitive impairment and normal participants. Power of rsEEG was assessed using Spearman correlation analysis. The significance level was set at P < 0.05. Results: The language ability [ 2.00 (0.75 ) vs 3.00 ( 0.00 )] and delayed memory [1.00 ( 1.75 ) vs 4.50 ( 2.00 ) ]of patients in group A were lower than those in group B. The visual space and execution ability[ 3.00 (1.75 ) vs 5.00 ( 0.00 ) ], computational power [ 2.00 ( 2.00 ) vs 3.00 ( 0.00 )], language ability [ 2.00 (0.75 ) vs 3.00 ( 0.00 )], and delayed memory [ 1.00 ( 1.75 ) vs 4.00 (1.75 )] in group A were lower than those in group C, the health participants (P < 0.05). The power spectrum ratios of frontal lobe, central region, temporal lobe, parietal lobe, and occipital lobe in group A were higher than those in groups B and C [ 3.68 ± 1.63 vs 1.66 ± 0.93 vs 0.47 ± 0.38; 2.13 ( 1.21 ) vs 0.47 ( 0.74 ) vs 0.19 ( 0.16 ); 1.82 ( 1.10 ) vs 0.85 ( 0.70 ) vs 0.29 ( 0.29 ); 1.64 ( 0.89 ) vs 0.59 ( 0.51 ) vs 0.20 ( 0.05 ); 0.83 ( 0.61 ) vs 0.38 ( 0.35 ) vs 0.11 ( 0.09 )] (P < 0.05). The language ability of patients with cognitive impairment was negatively correlated with the power spectrum ratio of the central area, temporal lobe and parietal lobe (r = -0.760、-0.756、-0.756,P < 0.05). Conclusion: Chronic pain patients with cognitive impairment are characterized by decreased language ability and delayed memory. The language ability is negatively correlated with the power spectrum ratio of the central area, temporal lobe, and parietal lobe. These findings suggest that electroencephalogram power spectrum ratio may be used as a quantitative biomarker for early recognition of cognitive impairment in patients with chronic pain.