摘要
目的探讨不同程度的缺血性卒中后认知障碍(PSCI)的危险因素及认知训练效果。方法连续纳入2019年1月至2021年4月于北京市中关村医院住院的缺血性脑卒中患者,根据蒙特利尔认知评分(MoCA)分为重度认知障碍组(MoCA≤15分)及轻度认知障碍组(15分<MoCA≤24分),采用单因素(t检验、秩和检验和χ2检验)及多因素回归分析比较2组患者的一般人口学资料、生化指标、既往病史、卒中病灶部位、美国国立卫生研究院卒中量表(NHISS)评分、脑小血管病(CSVD)总负荷评分。入组患者完成规律认知训练,3个月后复测MoCA量表,比较训练前后效果。结果共纳入64例PSCI患者,重度认知障碍组40例,轻度认知障碍组24例。单因素分析发现重度认知障碍组较轻度认知障碍组在年龄、NIHSS、同型半胱氨酸、C反应蛋白、CSVD总负荷评分方面明显升高[77.5(75.0,81.0)岁vs70.0(66.0,76.0)岁;7.5(2.5,8.0)分vs3.0(2.0,5.0)分;14.7(11.04,19.35)μmol/Lvs12.29(9.57,14.80)μmol/L;3.61(0.97,9.09)mmol/Lvs1.50(0.56,3.45)mmol/L;2.0(2.0,3.0)分vs1.0(0,2.0)分],差异均具有统计学意义(Z=-3.636、-2.742、-2.226、-2.207、6.542,P<0.001、<0.001、=0.008、=0.001、<0.001),在血红蛋白、空腹血糖、糖化血红蛋白、低密度脂蛋白及甘油三酯方面明显降低[(122.25±17.32)g/Lvs(134.46±16.09)g/L;5.56(4.88,6.34)mmol/Lvs7.82(6.29,10.23)mmol/L;5.8%(5.60%,7.05%)vs7.7%(6.50%,8.70%);2.07(1.66,2.76)mmol/Lvs2.55(2.22,3.18)mmol/L;1.15(0.95,1.58)mmol/Lvs1.79(1.28,2.52)mmol/L],差异均具有统计学意义(t=-2.802,P=0.006;Z=-2.794,P=0.001;Z=-2.794,P<0.001;Z=-1.588,P=0.006;Z=-2.684,P=0.001)。多因素Logistic回归分析显示CSVD总负荷评分(OR=4.536,95%CI:1.558~13.210,P=0.006)是PSCI重度认知障碍组的独立影响因素。认知训练后轻度认知障碍组MoCA及语言、抽象思维、延迟回忆改善较重度认知障碍组明显[4.0(3.0,4.5)分vs3.0(2.0,4.0)分;0(0,1.0)分vs0(0,1.0)分;1.0(0,1.0)分vs0(0,0)分;1.0(0,1.0)分vs0(0,0)分],差异具有统计学意义(Z=-2.848、-3.900、-2.671、-3.044,P=0.004、<0.001、=0.008、0.002)。结论CSVD总负荷加重了PSCI;规律的认知训练可有效改善PSCI。
ObjectiveTo investigate the difference in risk factors between mild and severe post-stroke cognitive impairment and the effect of regular cognitive training.MethodsPatients with ischemic stroke,admitted to Zhongguancun Hospital in Beijing from January 2019 to April 2021,were included and classified as post-stroke severe cognitive impairment group(MoCA≤15 points)and mild post-stoke Cognitive impairment group(MoCA>15 and≤24 points).Univariate(ttest、Wilcoxon rank sum test andχ2test)and multivariate comparative regression analysis was used to compare the demographic data,biochemical parameters,medical history,location of stroke lesion,NHISS,and total cerebral small vascular disease(CSVD)load in the two groups.The enrolled patients were given regular cognitive training.MoCA test was performed again 3 months later to compare the effect before and after training.ResultsA total of 64 patients were enrolled,including 40 patients in the severe PSCI group and 24 in the mild PSCI group.Univariate analysis showed that age,NIHSS,homocysteine,CRP,and CSVD total load score were significantly higher in severe PSCI group than those in mild PSCI group[77.5(75.0,81.0)yearsvs70.0(66.0,76.0)years;7.5(2.5,8.0)pointsvs3.0(2.0,5.0)points;14.7(11.04,19.35)μmol/Lvs12.29(9.57,14.80)μmol/L;3.61(0.97,9.09)mmol/Lvs1.50(0.56,3.45)mmol/L;2.0(2.0,3.0)pointsvs1.0(0,2.0)points],the differences were statistically significant(Z=-3.636,-2.742,-2.226,-2.207,6.542;P<0.001,<0.001,=0.008,=0.001,<0.001).Hemoglobin,blood glucose,glycosylated hemoglobin,low density lipoprotein and triglyceride were significantly reduced[(122.25±17.32)g/Lvs(134.46±16.09)g/L;5.56(4.88,6.34)mmol/Lvs7.82(6.29,10.23)mmol/L;5.8%(5.60%,7.05%)vs7.7%(6.50%,8.70%);2.07(1.66,2.76)mmol/Lvs2.55(2.22,3.18)mmol/L;1.15(0.95,1.58)mmol/Lvs1.79(1.28,2.52)mmol/L],the differences were statistically significant(t=-2.802,P=0.006;Z=-2.794,P=0.001;Z=-2.794,P<0.001;Z=-1.588,P=0.006;Z=-2.684,P=0.001).Multivariate logistic regression analysis showed that CSVD score was an independent factor in the severe PSCI group(OR=4.536,95%CI:1.558~13.210,P=0.006).MoCA,language,abstraction and delayed recall improved significantly in the mild cognitive impairment group after cognitive training compared with the severe group[4.0(3.0,4.5)scorevs3.0(2.0,4.0)score;0(0,1.0)scorevs0(0,1.0)score;1.0(0,1.0)scorevs0(0,0)score;1.0(0,1.0)scorevs0(0,0)score],the differences were statistically significant(Z=-2.848,-3.900,-2.671,-3.044;P=0.004,<0.001,=0.008,0.002).ConclusionCSVD score was an independent influencing factor of severe cognitive impairment.Regular cognitive training can effectively improve the level of cognitive impairment after stroke.
作者
刘欣
王丽娟
刘荧
王爽
徐绍红
李小刚
Liu Xin;Wang Lijuan;Liu Ying;Wang Shuang;Xu Shaohong;Li Xiaogang(Department of Neurology,Beijing Zhongguancun Hospital,Beijing 100190,China;Department of Neurology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华脑血管病杂志（电子版）》
2022年第5期314-319,共6页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
基金
北京市海淀区预防医学会(2018HDPMA11)
关键词
卒中后认知障碍
危险因素
认知训练
认知测评
脑小血管病
Post-stroke cognitive impairment
Risk factors
Cognitive training
Cognitive test
Cerebral small vessel disease
作者简介
通信作者:李小刚,Email:xgangli2002@163.com
