急性脑梗死的认知功能障碍特点分析被引量：29

Characteristics of cognitive dysfunction in acute cerebral infarction

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摘要目的探索急性脑梗死后认知功能障碍的发生率,分析不同梗死部位认知域损害特点。方法选取2016年1月至2019年1月新疆医科大学附属中医医院脑病科收治的急性脑梗死患者213例,根据神经心理量表测评结果分为卒中后无认知障碍组(NCI)、卒中后认知功能障碍非痴呆组(PSCIND)、卒中后痴呆组(PSD),收集患者临床资料及影像资料,进行统计分析。结果急性脑梗死患者认知功能障碍发生率高达78.4%;MMSE评分显示:非优势侧大脑梗死的延迟回忆能力受损明显[非优势/优势(1.80±1.05)/(1.55±1.11);P=0.025];额叶梗死语言复述受损明显[有/无(0.32±0.30)/(0.63±0.41);P=0.008];顶叶梗死即时记忆[有/无(1.91±1.09)/(2.99±1.12)分;P=0.04]和语言复述[有/无(0.22±0.3)/(0.59±0.5)分;P=0.012]受损明显。MOCA评分显示:非优势侧大脑半球梗死的MOCA总分高于优势侧大脑[非优势/优势(17.54±6.65)/(16.65±6.40);P=0.041]。优势侧大脑半球梗死与非优势侧梗死语言功能、延迟回忆受损差异具有统计学意义;额叶梗死的语言功能[有/无:(1.41±0.91)/(2.32±1.02)分;P=0.014]、命名[有/无:(1.90±1.03)/(2.94±1.26)分;P=0.019]和定向[有/无:(2.15±1.10)/(4.28±1.36)分;P=0.000]受损明显;顶叶梗死延迟回忆[有/无:(1.32±1.10)/(0.91±0.94)分;P=0.000]、注意力[有/无:(2.2±0.4)/(2.5±0.6)分;P=0.038]、语言[有/无:(1.5±1.2)/(2.3±1.1)分;P=0.009]功能受损。基底节区梗死语言功能[有/无:(1.52±1.31)/(2.52±1.06)分;P=0.001]、定向[有/无:(2.73±1.37)/(3.71±1.68)分;P=0.006]受损。多因素回归分析结果显示:额叶(,P=0.008)、颞叶(P=0.020)、小脑(P=0.008)梗死增加认知功能障碍风险。结论脑梗死急性期患者认知功能障碍的发生率较高,认知域损害特点与梗死部位具有相关性;额叶、颞叶、小脑梗死增加认知功能障碍的发生率。 Objective Exploring the incidence of cognitive dysfunction after acute cerebral infarction and analyse the characteristics of cognitive domain damage in different infarct sites.Methods Selected from January 2016 to January 2019213 patients with acute cerebral infarction treated by the Department of Encephalopathy,Chinese Medical Hospital of Xinjiang Medical University,according to theneuropsychological scale scores divided into three groups as follow:normal cognitive group(NCI,n=46),post-stroke cognitive impairment not dementia group(PSCIND,n=91),and poststroke dementia group(PSD,n=76).Clinical data and imaging data,The neuropsychological scale was evaluated.Results The incidence of cognitive dysfunction in patients with acute cerebral infarction reached 78.4%;MMSE score showed that the delayed recall ability of non-dominant cerebral infarction was significantly impaired[non-dominance/dominance(1.80±1.05)/(1.55±1.11);P=0.025];Frontallobes infarction impaired language recapitulation[Yes/No(0.32±0.30)/(0.63±0.41);P=0.008];Immediate memory[Yes/No(1.91±1.09)/(2.99±1.12);P=0.04]and verbal repetition[Yes/No(0.22±0.3)/(0.59±0.5);P=0.012]of parietal infarction was significantly damaged.The MOCA score showed that the total MOCA score of non-dominant cerebral infarction was higher than the advantage side brain[Non-advantage/Advantage(17.54±6.65)/(16.65±6.40);P=0.041].Language function of the cerebral infarction on the dominant side is significantly impaired[Non-advantage/Advantage:(1.66±1.10)/(1.22±0.98)Score;P=0.004].Delayed recall ability was significantly impaired in non-dominant cerebral infarction[non-dominance/advantage:(1.55±1.45)/(0.97±1.37);P=0.010].Language function[Yes/No:(1.41±0.91)/(2.32±1.02)points;P=0.014],named[Yes/No:(1.90±1.03)/(2.94±1.26);P=0.019]and orientation[Yes/No:(2.15±1.10)/(4.28±1.36)points;P=0.000]were significant damaged in frontal infarction;delayed recall[Yes/No:(1.32±1.10)/(0.91±0.94)points;P=0.000],attention[Yes/No:(2.2±0.4)/(2.5±0.6)points;P=0.038],language[Yes/No:(1.5±1.2)/(2.3±1.1);P=0.009]were significant damaged in parietal infarction.Language function[Yes/No:(1.52±1.31)/(2.52±1.06)points;P=0.001],orientation[Yes/No:(2.73±1.37)/(3.71±1.68)points;P=0.006]were significant damaged in basal ganglia infarction.The results of multivariate regression analysis showed:frontal lobe(P=0.008),temporal lobe(P=0.020),cerebellum(P=0.008)infarction increased risk of cognitive dysfunction.Conclusion The damage of different cognitive domains in patients with acute stage of cerebral infarction is related to the infarct site;The characteristics of cognitive domain damage were correlated with the infarct site;Infarction of the frontal,temporal and cerebellum increases the incidence of cognitive dysfunction.

作者李丹刘婷刘佳房江山马娜杜帅张燕张玉洁孟新玲 LI Dan;LIU Ting;LIU Jia(Department of Encephalopathy,Chinese Medical Hospital of Xinjiang MedicalUniversity,Urumqi 830000,Xinjiang,China)

机构地区新疆医科大学附属中医医院脑病一科不详

出处《中风与神经疾病杂志》 CAS 2020年第11期1016-1020,共5页 Journal of Apoplexy and Nervous Diseases

基金新疆维吾尔自治区自然科学基金资助项目(编号:2017D01C153)。

关键词脑梗死急性期梗死部位认知功能障碍神经心理量表 Acute phase of cerebral infarction Infarction location Cognitive dysfunction Neuropsychological scale

分类号 R743.3 [医药卫生—神经病学与精神病学]

作者简介通讯作者:孟新玲,E-mail:altmxl@126.com。

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