老年腔隙性脑梗死后影响认知功能障碍的危险因素分析

Risk Factors of Cognitive Impairment After Lacunar Cerebral Infarction in Elderly Patients

目的探讨影响老年腔隙性脑梗死患者认知功能障碍的主要危险因素,为老年腔隙性脑梗死的早期预防和干预提供依据。方法将102例腔隙性脑梗死老年患者列为观察组,并选择84例非腔隙性脑梗死患者为对照组,使用蒙特利尔认知评估量表(Mo CA)进行认知功能评估,比较两组认知功能评分和认知功能障碍率。观察组患者在入院1年后再行评估,比较入院时和1年后的评分变化,并采用Logistic回归分析总结危险因素。结果观察组视空间与执行功能、注意力、语言、延迟回忆和认知功能总分分别为3.25±0.83、4.45±0.71、2.26±0.61、2.58±1.31、22.64±2.91,均显著低于对照组(t=7.201、11.230、7.433、3.331和9.369,P<0.05)。观察组认知功能认知障碍率为50.98%,显著高于对照组(χ2=8.549,P<0.05)。观察组1年后认知功能评分为22.51±3.23,与入院时无统计学差异(t=1.325,P=0.396)。其中:26例患者在1年后Mo CA评分显著下降(t=3.983,P=0.033)。Logistic回归结果显示糖尿病、高脂血症是导致老年腔隙性脑梗死患者认知功能障碍的主要危险因素(P=0.034、0.011)。结论老年腔隙性脑梗死患者存在一定的认知功能障碍。部分患者随着病程的延长,认知功能障碍有加重的趋势。与高血压、颈动脉斑块、吸烟史相比,合并糖尿病、高脂血症的老年腔隙性脑梗死患者更容易发生认知功能障碍。

Objective To explore the main influencing factors of cognitive impairment of elderly patients with lacunar cerebral infarction, so as to provide basis for early prevention and intervention. Methods 102 cases of elderly patients with lacunar cerebral infarction were selected as the observation group, and 84 cases of elderly patients with non-lacunar cerebral infarction were selected as the control group. Cognitive function was evaluated by Montreal cognitive assessment（Mo CA） scale, and the cognitive function score and cognitive dysfunction rate were compared. The risk factors were summarized by Logistic regression analysis. Results The scores of visuospatial and executive functions, attention, language and delayed recall, and total cognitive function score of observation group were3.25 ± 0.83、 4.45 ± 0.71、 2.26 ± 0.61、 2.58 ± 1.31、 22.64 ± 2.91 respectively, significantly lower than those of control group（all P〈0.05）.The rate of cognitive dysfunction of observation group was 50.98%, significantly higher than that of control group（P〈0.05）. The cognitive function score at one year later of observation group was 22.51 ± 3.23, with no statistical difference compared with that on admission, in which, 26 patients had significant decrease at one year later（t = 3.983, P = 0.033）. Logistic regression analysis showed that diabetes and hyperlipidemia were the main risk factors of cognitive impairment after lacunar cerebral infarction in elderly patients（P = 0.034, P = 0.011）.Conclusions Elderly patients with lacunar cerebral infarction have certain cognitive dysfunction. Some patients have the trend that the cognitive impairment has aggravated with the extension of course. Compared with those patients with hypertension, carotid artery plaque and smoking history, the lacunar infarction patients with diabetes and hyperlipidemia are more prone to happen cognitive dysfunction.