首次发作脑梗死患者认知障碍发生率:434例分析(英文)

Incidence of cognitive impairment after the first onset of cerebral infarction: Analysis of 434 cases

背景:出现认知功能障碍是脑卒中生存者功能恢复较差的强预测因子。缺血性脑卒中后认知功能障碍的发生率及可信区间分析对预防脑卒中后发生认知功能障碍及区别老年期认知功能障碍有实用意义。目的:探讨新发缺血性脑卒中患者认知功能障碍的发生率。设计:3个月随访的单因素病例分析。单位:解放军第三军医大学大坪医院野战外科研究所。对象:选择1999-05-08/2000-12-31解放军第三军医大学大坪医院神经内科的急性脑梗死患者434例,男218例,女216例,年龄55～85(70.3±9.5)岁,均为新发脑卒中48h内入院,并自愿参加此项目。方法:入院时收集患者的人文资料和临床资料。发病后7～10d和出院后3个月应用简易智能量表(由20题组成,共30项。分为5个方面:定向力、记忆力、计算力及回忆、语言。每项回答正确得1分,回答错误或答不知道评0分,量表总分范围为0～30分)对患者进行认知功能障碍测试。认知功能障碍的诊断标准为脑卒中后3个月简易智能量表分值低于划界值(文盲17分,≤6年受教育水平20分,≥7年受教育水平24分)。主要观察指标:①出院后3个月认知功能障碍的发生率。②脑梗死后认知功能障碍患者简易智能量表评分的单因素分析。结果:434例患者均进入结果分析。①出院后3个月434例脑梗死患者中161例被诊断为脑卒中后认知功能障碍,发生率为37.1%(161/434),认知功能正常273例,为62.9%(273/434)。②脑梗死后认知功能障碍组的平均年龄明显高于认知功能正常组犤(73.0±7.0)岁,(64.5±6.6)岁,t=2.626,P<0.01犦。≤6年文化程度者比例显著高于认知功能正常组犤45.3%,22.7%,OR=2.823,95%可信区间为1.855～4.297犦。简易智能量表评分明显低于认知功能正常组犤(16.3±8.7)分,(23.4±4.2)分,t=3.352,P<0.001犦。结论:老年脑梗死患者认知功能障碍的发生率较高。脑梗死后发生认知功能障碍者年龄明显偏高,接受教育水平明显偏低,提示脑梗死后认知功能障碍与患者的年龄、受教育水平等变量因素有明显的协同效应。

BACKGROUND： The presence of cognitive impairment following stroke onset strongly indicates poor prognosis of the patients surviving the crisis. Understanding of the incidence of cognitive impairment after ischemic stroke and its confidence interval has practical significance in preventing is occurrence in stroke patients and its differentiation from age-related cognitive impairment. OBJECTIVE： To study the incidence of cognitive impairment in patients with the first onset of ischemic stroke. DESIGN： Single-factor analyses of the cases followed up for 3 months SETTING： Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA. PARTICTPANTS： Totally 434 inpatients with acute cerebral infarction [218 male and 216 female, aged 55 to 85 with a mean of （70.3±9.5） years] admiued within 48 hours after the onset in Department of Neurology, Daping Hospital of Third Military Medical University from May 8, 1999 to December 31, 2000. All patients participated in this study voluntarily. METHODS： The general background and clinical data of the patients were collected at the time of admission. A simplified intelligence test was performed both 7 to 10 days of the onset and 3 months after discharge. The scale employed for the test included 20 questions with a total of 30 items divided to test 5 aspects of the patients＇ cognition, namely orientation ability, memory, calculation ability, memory recall and linguistic ability （1 point was given for a correct answer, and 0 for an wrong one or an answer of “1 don＇t know”, with the total score of 30 for all items）. A score of the simplified intelligence test less than the score of demarcation （specifically, below 17 for illiterate patients, below 20 for those receiving an education no more than 6 years, and below 24 for those having an education for no less than 7 years） for 3 months after cerebral stroke was regarded as the diagnostic criteria for cognitive impairment. MAIN OUTCOME MEASURES： The incidence of cognitive impairment was recorded 3 months after hospital discharge and single-factor analysis of the scores of simple intelligence test. RESULTS： All the 434 patients were included in result analysis. Totally 161 （37.1%） patients were diagnosed as having cognitive impairment, and 273 （62.9%） had normal cognitive function 3 months after hospital discharge. The mean age of the patients with cognitive impairment was significantly higher than that of the patients with normal cognitive function [（73.0±7.0） years vs （64.5±6.6） years, t=2.626, P 〈 0.01]. The proportion of patients with cognitive impairment receiving education for no more than 6 years was significantly higher than that among patients with normal cognition （45.3% vs 22.7%, 0R=2.823, with 95% confidence interval of 1.855 -4.297）, and the score of simple intelligence test was significantly lower in the former patient group （16.3±8.7 vs 23.4±4.2, t=3.352, P 〈 0.001）. CONCLUSION： The incidence of cognitive impairment in this cohort is relatively high. The patients with cognitive impairment following cerebral infarction have obviously older age and poorer education, suggesting significant synergetic effect of age and education with cognitive impairment following cerebral infarction.