浙江地区缺血性脑卒中患者早期认知功能障碍的检出率及危险因素分析

Incidence and risk factors of early post-stroke cognitive impairment in patients with ischemic stroke: a multicenter registry study in Zhejiang province in east China

目的:探索缺血性卒中患者早期认知功能障碍(early post-stroke cognitive impairment,ePSCI)检出率和危险因素。方法:基于中国大陆东部浙江省三级医院住院患者的多中心登记研究。纳入起病2周内的缺血性卒中患者,利用ADS-cog和CDR量表评估认知功能以及HAMD量表评估抑郁情绪。根据DSM-IV标准诊断e PSCI,包括卒中后轻度认知功能障碍(Poststrokemild cognitiveimpairment, psMCI)及卒中后痴呆(poststroke dementia, psDEM)。应用Logitic回归分析psMCI和psDEM危险因素。结果:共948例缺血性卒中患者纳入统计。ePSCI检出率是58.6%。教育是psMCI(OR=0.918(0.873-0.964), P=0.001)和psDEM(OR=0.815(0.742-0.895), P<0.000)保护因素。年龄是psMCI(OR=1.047(1.022-1.072), P<0.000)和psDEM(OR=1.096(1.051-1.143), P<0.000)危险因素。心血管疾病史是psMCI危险因素(OR=1.859(1.006-3.435),P=0.048)。抑郁是psMCI(OR=1.067(1.015-1.121), P=0.011)和psDEM(OR=1.266(1.162-1.380), P<0.000)危险因素。结论:缺血性卒中患者ePSCI检出率高达50%以上。长年限教育是保护因素,高龄、卒中前工作、心血管疾病史和抑郁情绪是危险因素。

Background Early post-stroke cognitive impairment(ePSCI)was often overlooked in clinical practice.Our aim was to identify the incidence and risk factors for ePSCI in patients with ischemic stroke.Methods Patients who had ischemic stroke in the last 2 weeks were included.Cognitive function was evaluated by the Alzheimer’s Disease Assessment Scale-Cognitive subscale(ADAS-Cog).ePSCI including post-stroke mild cognitive impairment(psMCI)and post-stroke dementia(psDEM)was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)criteria.Logistic regression analysis was used to analyze the risk factors for psMCI and psDEM.Results 948 patients were included.The incidence of ePSCI was 58.6%.Education was a protective factor for psMCI(OR=0.918(0.873-0.964),P=0.001)and for ps DEM(OR=0.815(0.742-0.895),P<0.000).Age was a risk factor for psMCI(OR=1.047(1.022-1.072),P<0.000)and for psDEM(OR=1.096(1.051-1.143),P<0.000),as well as history of cardiovascular diseases(CVD)for psMCI(OR=1.859(1.006-3.435),P=0.048),depression for psMCI(OR=1.067(1.015-1.121),P=0.011)and for ps DEM(OR=1.266(1.162-1.380),P<0.000).Conclusion The incidence of ePSCI in patients with ischemic stroke was greater than 50%.Long period of education is a protective factor,while age,employment,history of cardiovascular diseases,and depression are risk factors.