基底核出血和梗死后认知功能的随访研究

Cognitive function after basal ganglia hemorrhage and infarction:a follow-up study

目的探讨基底核出血和梗死急性期及恢复期的认知损害特点和差异。方法观察组共91例患者,其中基底核出血48例,基底核梗死43例。观察组在卒中后急性期(卒中后3周内)及卒中后恢复期(卒中后6～9个月)各完成一次神经心理学测验。健康对照组77名,完成一次神经心理学测验。结果基底核出血组和梗死组在急性期的各个认知域评分与对照组比较,差异均有统计学意义(P<0.05)。除执行功能(语义分类流畅性)外,基底核出血组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义(P<0.05)。恢复期基底核出血组的记忆力、执行功能(语义分类流畅性)、信息处理速度(数字符号测验)、视空间结构能力(积木测验和画钟测验)评分与健康对照组比较,差异亦有统计学意义(P<0.05),而简易精神状态检查量表(MMSE)、注意力、执行功能(Stroop测验C)和信息处理速度(Stroop测验A)评分与健康对照组比较,差异无统计学意义(P>0.05)。除注意力(数字广度顺背测验)、记忆力(再认)和执行功能(语义分类流畅性测验)外,基底核梗死组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义(P<0.05)。基底核梗死组恢复期记忆力、信息处理速度(数字符号测验)、视空间结构能力(积木测验和画钟测验)评分与健康对照组比较,差异具有统计学意义(P<0.05),而MMSE、执行功能(Stroop测验C)和信息处理速度(Stroop测验A)评分与健康对照组比较,差异无统计学意义(P>0.05)。结论基底核卒中急性期出现多个认知领域的损害,恢复期大部分认知域得到改善,其中部分认知域可基本达到健康对照水平。

Objective To investigate the characteristics and differences of cognitive impairment after first attack of basal ganglia hemorrhage and infarction in acute and convalescent phases. Methods A total of 91 patients were collected in the observation group, 48 of them had basal ganglia hemorrhage, and 43 had basal ganglia infarction. The neuropsychological tests were carried out twice in the post-stroke acute phase （3 weeks after stroke） and convalescent phase （6 to 9 months after stroke） in the observation group; 77 healthy persons in the control group whom also completed the neuropsychological tests. Results There were significant differences in the score of each cognitive domain in the basal ganglia hemorrhage and basal ganglia infarction groups in acute phase as compared to the control group （ P 〈 0.05 ）. In additional to executive function （semantic category fluency） , there was significant difference in the neuropsyehological test scores in the convalescent phase as compared to the acute phase in the basal ganglia hemorrhage group （P 〈0.05）. There were also significant differences in the scores of the memory, executive function （semantic category fluency）, information processing speed （digit-symbol test）, vision-spatial ability （block test and clock drawing test） in convalescent phase in the basal ganglia hemorrhage group as com- pared to those in the control group （P 〈 O. 05 ） , while there were no significant differences in the scores of the mini-mental state examination （MMSE）, attention, executive function （Stroop C） and information pro- cessing speed （Stroop A） as compared to those in the healthy control group （P 〉 O. 05）. In addition to at- tention （the forward and backward digit span test）, memory （recognition） and executive function （the se- mantic category fluency test）, there was significant difference between the convalescent phase and the acute phase in the scores of the neuropsychological test of the basal ganglia infarction group （ P 〈 O. 05 ）. There were significant differences in the scores of memory, information processing speed （ digit-symbol test ）, visuospatial and visuoconstructive abilities （block test and clock drawing test） in the convalescent phase of the basal ganglia hemorrhage group when compared to those of the healthy control group （ P 〈 O. 05 ）, while there were no significant differences in the scores of MMSE, executive function （ Stroop C） and information processing speed （Stroop A） of the basal ganglia hemorrhage group when compared to those of the healthy control group （P 〉 0.05）. Conclusion There are several cognitive impairments in the acute phase of basal ganglia stroke. Most cognitive domains are improved in the convalescent phase. A part of them may be basically achieved to the healthy control level.