脑梗死后痴呆的临床分析

Clinical study on dementia after cerebral infarction

目的 脑梗死是产生痴呆的一重要原因 ,但其产生痴呆的危险因素和机制尚不清楚。方法 2 57例脑梗死患者在入院时均进行临床和智能评估、血生化和头颅 CT/ MRI检查。于病程 2个月后 ,再用 MMSE量表进行智能评定 ,应用 Hachinski缺血指数区分 Alzheimer痴呆和血管性痴呆。结果 脑梗死后痴呆的发生率为3 5.80 %。年龄越大 ,文化程度越低则痴呆的发生率愈高 ;既往有卒中史、房颤史和冠心病史的脑梗死患者 ,其痴呆的概率明显升高 ;它不仅与血糖、纤维蛋白原、血脂及血肌酐水平升高密切相关 ,也与脑梗死的部位、体积、病灶数目和神经功能缺损的严重性密切联系 ( P<0 .0 5)。结论 脑梗死后痴呆较为常见 ,它是多因素相互作用的结果。它不仅与患者自身素质 (高龄、低教育 )、脑梗死的某些危险因素有关 ,而且大面积梗死、优势半球梗死、多发性梗死及神经功能缺损的严重性对此也起了十分重要的作用。

Objective Cerebral infarction was regarded as an important cause of dementia. The characteristics and risk factors for dementia related to cerebral infarction were still incompletely understood. Method 257 consecutively hospitalized patients who at admission after cerebral infarction completed clinical and cognitive assessments, serum biochemistry and head CT or MRI examination. The Mini Mental State Examination(MMSE) was used again to assess the cognitive performance of these patients after two months. To distinguish Alzheimer's dementia(AD) from vascular dementia(VD) by Hachinski ischemic index. Results The frequency of dementia after cerebral infarction was 35.80%. The patients with dementia after cerebral infarction were older and more often had a low level of education. They more often had histories of prior cerebral infarction, atrial fibrillation and coronary heart disease. Dementia after cerebral infarction was related not only to increased levels of blood sugar, blood fat, fibrinogen and creatin, but also to the locations, numbers and volume of foci and high neurological deficit scale score at admission(P<0.05). Conclusion Dementia is frequent after cerebral infarction. Multiple factors contribute to the risk. It is associated with host characteristics (senility, low education) and some risk factors for stroke. Large volume infarct, left hemisphere infarct, multiple infarcts and stroke severity may play an important role in it.