脑卒中后失语患者认知功能评估的相关因素研究及年龄差异

Clinical characteristics and related factors of cognitive impairment in elderly post-stroke aphasia patients

目的探讨卒中后失语患者认知功能障碍相关因素及老年卒中后失语患者的认知功能特点。方法共纳入自2013年4月至2014年11月在南方医院、南方燕岭医院、广东省第二人民医院、南沙中心医院神经内科住院的82例急性脑卒中患者，其中失语患者62例．以年龄60岁为界分为老年组（n=30，实验组）及非老年组（n=32，对照组Ⅰ），余20例为脑卒中后非失语患者（年龄≥60岁）为对照组Ⅱ。记录患者的临床资料、美国国立卫生研究院脑卒中量表（NIHSS）评分、头颅MRI／CT结果。脑卒中发病7d后进行失语评定、抑郁评分及非语言认知功能评分．失语患者以波士顿诊断失语检查（BDAE）进行失语严重程度分级。卒中后失语患者认知评分的影响因素分析采用多元回归法。结果（1）多元回归分析提示与认知功能评分下降相关的因素有严重失语（β=0．637，P=0．000）、年龄（β=-0．392，P=0．000）、抑郁评分（β=-0．176，P=0．035）、病灶累及皮层（β=-0．150，P=0．049）。（2）与对照组Ⅰ相比，除逻辑推理能力外，实验组总体及其余各认知领域受损发生率明显增高、认知评分明显降低，差异均有统计学差异（P〈0．05）；与对照组Ⅱ相比，除视空间能力外，实验组总体及各个认知领域受损的发生率明显增高、认知评分明显降低，差异均有统计学差异（P〈0．05）。（3）与记忆力、注意力、执行力相比，老年组患者逻辑推理能力明显降低（P〈0．05）。（4）与对照组Ⅰ、Ⅱ相比，实验组患者认知功能障碍累及领域更广，差异有统计学意义（P〈0．05）。结论在脑卒中后失语患者中，失语严重程度对认知功能的影响最显著，其次为年龄、抑郁程度及皮层病灶：在失语严重程度、抑郁程度及皮层病灶相同的情况下，老年脑卒中后失语患者认知功能障碍的发生率、认知功能下降程度及受损广度均较中青年脑卒中后失语患者明显升高。

Objective To explore the clinical characteristics and related factors of cognitive impairment in elderly post-stroke aphasia （PSA） patients. Methods Eighty-two patients after stroke, admitted to our hospitals between April 2013 and November 2014, were enrolled in this study, including 62 patients with aphasia. Based on the criteria for age segmentation from World population ageing 2009 [6], these patients were divided into 3 groups with ＂age=60 years＂： PSA patients older than 60 years as experimental group （n=30）, PSA patients younger than 60 years as control group Ⅰ （n=32）, and non-aphasia patients older than 60 years as control group Ⅱ （n=20）. The clinical data, NIHSS scores and MRI/CT results of these patients were recorded; and the assessments of language ability, post-stroke depression （PSD） and nonlinguistic cognition were performed; classification of aphasia severity of the patients was performed by Boston diagnostic aphasia examination （BDAE）. Multivariate regression analysis was performed to examine relative factors of cognitive impairment in PSA patients. Results （1） Nonlinguistic cognitive scores were significantly correlated with BDAE scores （β=0.637, P=0.000）, age（β=-0.392, P=0.000）, SADQ-H scores（β=-0.176, P=0.035） and cortical lesions（β=-0.150, P=0.049）. （2） As compared with patients of control group Ⅰ, patients of experimental group were more likely showed deficits in most nonlinguistic cognitive domains except for abstract reasoning; and the cognitive function scale scores were significantly decreased （P〈0.05）; patients of experimental group had significantly increased number of nonlinguistic cognitive domains and significantly decreased cognitive function scale scores, except for visual perception and construction scores as compared with patients of control group Ⅱ （P〈0.05）. （3） The prevalence of abstract reasoning impairment was significantly lower as compared with that of visual memory, attention and executive functioning in patients of experimental group （P〈0.05）. （4） The frequency and severity of impaired cognitive domains in the experiment group were significantly higher than those in the control group Ⅰ and Ⅱ （P〈0.05）. Conclusions Nonlinguistic cognitive impairment is extremely common in elderly PSA patients. The aphasia severity and age are most associated with cognitive impairment in PSA patients, post-stroke depression and cortical lesions also have an effect on cognitive scores.