脑卒中后认知损害与影像学分型的相关研究

Analysis on the characteristics of cognitive impairment of different parts of the stroke

目的探讨不同部位缺血性脑卒中急性期患者认知功能损害的特点。方法收集230例脑梗死急性期(1～14 d)患者,包括额叶31例,颞叶27例,顶叶26例,枕叶21例,基底节47例,丘脑35例,小脑23例,脑干20例;采用中文版蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)对受试者进行认知功能测评。结果 (1)各病变部位认知障碍的发生率不同;额叶组、颞叶组及丘脑组MoCA总分低于其他各组(P<0.05),顶叶组、枕叶组MoCA总分与基底节组、小脑组和脑干组比较有显著性差别(P<0.05);(2)额叶组在视空间及执行功能、注意认知域及MoCA总分值低于其他各组(P<0.05);颞叶组在命名、延迟回忆认知域分值低于其他各组,MoCA总分与顶叶组、枕叶组、基底节组、小脑组、脑干组有显著性差异(P<0.05);顶叶组及枕叶组MoCA总分低于基底节、小脑、脑干组(P<0.05);丘脑组在视空间及执行功能、注意认知域及MoCA总分低于顶叶、枕叶、基底节、小脑和脑干组,语言及定向认知域分值低于其他各组(P<0.05)。结论不同部位脑梗死患者认知障碍的发生率及认知损害的特点不同。

Objective To explore the characteristics of cognitive impairment of the patients with differ- ent parts of ischemic stroke in acute phase. Methods 230 cases of acute cerebral infarction （1 - 14 days） pa- tients were collected , which included 31 cases of frontal lobe, 27 cases of temporal lobe, 26 cases of parietal lobe, 21 cases of occipital lobe, 47 cases of basal ganglia, 35 cases of thalamus, 23 cases of the cerebellum, and 20 cases of brain stem; the cognitive function for all subjects were evaluate by Chinese version of Montreal Cognitive Assessment Scale. Results The incidence of cognitive impairment for different position of ischemic stroke was different： the scores of frontal, temporal lobe and thalamus groups were lower than other groups （P〈0. 05） ; the scores in parietal and occipital lobe groups had a significant difference compared with the scores in basal ganglia, cerebellar and brainstem groups（P〈0. 05） ; the scores of frontal group in visuospatial and executive function and attention aspects were lower than other groups （P〈0. 05）, temporal lobe in naming and delayed recall aspects had a lower score compared with other groups ; the total MOCA scores in parietal and occipital groups were lower than in basal ganglia , cerebellums and brainstem groups （P〈0. 05）; the scores of thalamus group not only was lower than that of parietal lobe , occipital lobe , basal ganglia , cerebel lum and brainstem groups in visuospatial and executive function and attention aspects, but also had a lower score in language and directed cognitive domain aspects as compared with other groups （P〈0. 05） ;Conclusions The incidence and characteristics of cognitive impairment is different for different parts of the cerebral infarc tion.