急性轻型缺血性卒中患者认知功能损害特点及危险因素

Characteristics and risk factors for cognitive impairment in patients with acute mild ischemic stroke

目的探讨急性轻型缺血性卒中患者认知功能损害的特点、危险因素及预后。方法选取2019年3月—2020年2月在广州医科大学附属第五医院神经内科住院的45例急性轻型缺血性卒中患者作为观察组,并选取健康体检者50例作为对照组。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评估两组认知功能,并通过二分类logistic回归分析急性轻型缺血性卒中患者认知功能损害的危险因素,随访观察组1年,观察发病1周及1年后MoCA评分变化。结果两组认知损害率相比,观察组37.78%(17/45)高于对照组22.00%(11/50),差异有统计学意义(P<0.05);观察组MoCA总分及视空间与执行功能、抽象思维能力、延迟记忆力得分低于对照组,差异有统计学意义(P<0.05);两组命名、语言及定向力比较,差异无统计学意义(P>0.05);二分类logistic回归分析显示年龄、糖尿病、高同型半胱氨酸血症为急性轻型脑梗死患者认知功能损害主要危险因素,差异有统计学意义(P<0.05);33例患者发病1周(20.46±3.86)及1年后MoCA(20.03±3.28)评分比较,差异无统计学意义(P>0.05);33例观察组患者完成1年随访,13例发病1周MoCA评分<23分,1年后MoCA评分为(17.13±3.51)分,明显低于入院时(19.81±2.74)分,差异有统计学意义(P<0.05)。结论急性轻型缺血性卒中患者认知功能损害发生风险较高,以视空间与执行功能、抽象思维能力及记忆力损害为主;随病程延长,部分患者认知功能损害存在加重趋势;急性轻型缺血性卒中患者认知功能损害的主要危险因素为年龄、糖尿病、高同型半胱氨酸血症。

Objective This study was aimed at exploring the characteristics,risk factors and prognosis of cognitive impairment in patients with acute mild ischemic stroke.Methods A total of 45 patients with acute mild ischemic stroke who were hospitalized at the Department of Neurology of the Fifth Affiliated Hospital of Guangzhou Medical University from March 2019 to February 2020 were selected as the observation group,and 50 healthy people were selected as the control group.Cognitive impairment was evaluated with MoCA.Risk factors of cognitive impairment were analyzed through binary logistic regression analysis.After follow-up,the changes in MoCA scores 1 week and 1 year after onset were observed.Results The observation group had significantly lower MoCA scores than the control group(P<0.05).Visuospatial and executive function,abstract thinking ability and memory impairment scores were significantly lower in the observation group than the control group(P<0.05).The cognitive impairment rate was significantly higher in the observation group than the control group:37.78%(17/45)versus 21.82%(12/55)(P<0.05).The observation group had significantly lower MoCA scores than the control group(P<0.05).Visuospatial and executive function,abstract thinking ability and memory impairment scores were significantly lower in the observation group than the control group(P<0.05).Binary logistic regression analysis showed that age,diabetes and hyperhomocysteinemia were the main risk factors for cognitive impairment in patients with acute mild ischemic stroke(P<0.05).A total of 33 patients in the observation group were followed up for 1 year;13 patients had MoCA scores<23 at 1 week after onset,and the MoCA score at 1 year(17.13±3.51)was significantly lower than that at admission(19.81±2.74)(P<0.05).Binary logistic regression analysis showed that age,diabetes and hyperhomocysteinemia were the main risk factors for cognitive impairment in patients with acute mild ischemic stroke(P<0.05).Conclusion Patients with acute mild ischemic stroke are at high risk of cognitive impairment,mainly in visuospatial and executive functions,abstract thinking ability and memory impairment.Cognitive impairment tends to worsen in some patients as the disease progresses.The main risk factors for cognitive impairment in patients with acute mild ischemic stroke are age,diabetes mellitus and hyperhomocysteinemia.