卒中后认知功能变化规律及其影响因素分析

The evolution of cognition and its influence factors after stroke

目的研究卒中后认知功能的变化规律及其影响因素。方法收集西安交通大学医学院第一、第二附属医院和陕西省人民医院住院98例首发卒中患者，简短照料者问卷得分≤56分，卒中发病2周之内，无意识障碍及失语，至少一侧上肢肌力／〉3级，能够完成量表测查者，分别于卒中急性期（发病2周以内）、卒中后6、12周，应用简易精神状态量表（MMSE）和蒙特利尔认知功能评定量表（MoCA）评定认知功能。结果MMSE测定卒中急性期、卒中后6、12周认知功能障碍发生率分别为24．5％、12．1％和9．9％；MoCA测定卒中急性期、卒中后6、12周认知功能障碍发生率分别为86．8％、68．2％和38．0％。Logistic回归分析显示，与卒中后认知功能障碍相关的因素有高龄（B=-0．124）、高血压史（β=-3．705）、低教育程度（β=0．560）和卒中后抑郁（β=4．613）（P〈0．05）；而低教育程度（β=0．710）、冠心病史（β=-3．649）、TC水平增高（β=-3．361）、LDL—C水平增高（B=-5．833）和卒中后抑郁（β=-3．612）影响卒中后认知功能恢复（P〈0．05）。结论卒中后12周内认知功能逐渐改善，认知障碍发生率逐渐降低，低教育程度、冠心病史、TC、LDL—C水平增高和卒中后抑郁影响卒中后认知功能恢复。

Objective To investigate the evolution of cognitive function and its influence factors, so as to provide evidence for guiding treatment of cognitive impairment after stroke. Methods A total of 98 cases of patients with stroke admitted in the First and Second Affiliated Hospital of Medical College of Xi＇an Jiaotong University and Shaanxi Provincial People＇ s Hospital between April and September 2009 were enrolled and recruited. Mini-mental state examination（MMSE） and Montreal cognitive function rating scale （MoCA） were adopted to assess the evolution of cognition at acute phase（ within 2 weeks）, 6 weeks, and 12 weeks after stroke among patients within 2 weeks after onset, questionnaire score ≥56, without aphasia and consiousness disturbance and at least one side of upper extremities muscle force ≥ grade 3. Results When using MMSE scale as criteria, the incidence of cognitive impairment was 24. 5% at acute phase, 12. 1% at 6 weeks and 9.9% at 12 weeks after stroke, while the incidence was 86. 8% , 68.2% , and 38.0% respectively when using MoCA scale as criteria. The scales of MMSE and MoCA were increased and the incidence of cognitive impairment was decreased within 12 weeks after stroke. Logistic regression analysis indicated that, advanced age （ β = - 0. 124） , hypertension （ β = - 3. 705 ） , low education level （ β = 0. 560） and depression after stroke （ β = 4. 613 ） were related with cognitive impairment after stroke （ all P values 〈 0. 05） ; low education level（ β =0. 710） , coronary heart disease （ β = -3. 649） , elevated total cholesterol （TC） （β = -3. 361 ） and low density lipid cholesterol （LDL-C） （β = -5. 833）, and depression （β = -3. 612） delayed recovery of cognition after stroke. Conclusions The cognitive function improves and the incidence of cognitive impairment lowers as the time goes on within 12 weeks after stroke. The factors that may affect the improvement of cognitive function include low educational level, coronary heart disease, elevated TC and LDL-C, and post-stroke depression.