老年脑梗死患者认知功能下降的特点及危险因素分析

Characteristics and risk factors analysis of cognitive decline in elderly patients with cerebral infarction

目的探讨老年脑梗死患者认知功能下降的特点及其影响因素。方法采取横断面研究,在2014年11月13日至2014年12月21日对江苏省如皋市江安镇人群进行调查。样本来自"如皋衰老纵向研究",纳入31个村的1 788名对象,年龄70~84岁,均为汉族,其中男830名,女958名。确认脑梗死病史根据二级以上医院神经科诊断或头部CT证实。认知功能的评价采用改良长谷川痴呆量表,对该人群的定向力、记忆力、近记忆力、计算力及常识5个维度进行评价,总分>21.5为无认知功能障碍,≤21.5为有认知功能障碍。采用多因素Logistic回归分析老年脑梗死患者认知功能下降的危险因素。结果 (1)1 788名受检者中,合并脑梗死病史133例(7.4%),无脑梗死1 655名。合并脑梗死患者高血压的比例高于无脑梗死组[63.9%(85例)比41.7%(690例)],高密度脂蛋白胆固醇水平低于无脑梗死组[(1.40±0.29)mmol/L比(1.47±0.33)mmol/L],差异均有统计学意义(均P<0.05)。(2)合并脑梗死患者在定向力和计算力方面存在部分受损,总体认知功能评分为(20±7)分,较无脑梗死患者的(21±6)明显下降,两组比较差异有统计学意义(P<0.05)。(3)133例脑梗死患者中,存在认知功能障碍的76例,发生率为57.1%,其中女性59例。认知功能障碍患者血肌酐平均值为(59±15)μmol/L,较无认知障碍者(66±14)μmol/L明显降低,差异有统计学意义(P<0.05)。(4)多因素Logistic回归分析显示,小学以下教育程度(OR=2.86,95%CI:2.19~3.72)、女性(OR=1.85,95%CI:1.50~2.28),是老年脑梗死患者认知功能下降的独立危险因素,较高血肌酐浓度(OR=0.96,95%CI:0.95~0.97)是保护因素。结论脑梗死后的老年人总体认知功能下降,尤其是定向力和计算力方面受损明显。小学以下文化程度和女性是发生认知障碍的独立危险因素,较高水平血肌酐可能具有一定的保护作用。

Objective To investigate the characteristics and risk factors for cognitive decline in elderly patients with cerebral infarction. Methods A cross-sectional study was performed to investigate the population of Jiang＇an Town, Rugao,Jiangsu Province from November 13,2014 to December 21,2014. The samples from the Rugao longitudinal study of aging included 1 788 individuals from 31 villages aged from 70 to 84 years. They were all Han nationality, including 830 males and 958 females. History of cerebral infarction was identified according to the neurological diagnosis confirmed by the secondary hospital and above or brain CT. The modified Kyohko Hasegawa dementia scale was used to evaluate the cognitive function. Five dimensions （ orientation, memory, near memory,computing power,and common sense） of this population were assessed. The total score 〉 21.5 was non-cognitive impairment and ≤21.5 was cognitive impairment. Multivariate logistic regression was used to analyze the risk factors for cognitive decline in elderly patients with cerebral infarction. Results （1） In the 1 788 subjects, 133 had cerebral infarction （7.4%）, and 1 655 did not have cerebral infarction. The proportion of hypertension in patients with cerebral infarction was higher than that without cerebral infarction （63.9% [ n = 85 ] vs. 41.7% [ n = 690 ] ）. The high-density lipoprotein cholesterol level was lower than that of the non-cerebral infarction group （ 1.40 ± 0.29 mmol/L vs. 1.47 ± 0.33 mmol/L）. There was statistically significant difference （ all P 〈 0.05 ）. （2） The patients with cerebral infarction were partially impaired in orientation and computational power,and the overall cognitive function score was 20 ± 7, which was significantly lower than patients with non-cerebral infarction （21 ± 6 ）. The difference between the two groups was statistically significant （P 〈 0.05）. （3） In 133 patients with cerebral infarction, 76 had cognitive impairment, the incidence was 57.1% ,and 59 of them were women. The average value of serum creatinine in patients with cognitive impairment was 59 ± 15 μmol/L, which was significantly lower than those with non-cognitive impairment （66 ± 14 μmol/L）. There was significant difference （P 〈 0.05 ）. （4） Multivariate logistic regression analysis showed that the education level below primary school （OR, 2. 86,95 % CI 2.19-3.72 ） and female （OR, 1.85,95% CI 1.50-2.28） were the independent risk factors for cognitive decline in elderly patients with cerebral infarction. High serum creatinine concentration （ OR,0. 96,95% CI 0. 95 -0.97 ） was a protective factor for it. Conclusion The cognitive function of the elderly was decreased after cerebral infarction, especially in the aspect of orientation and calculation. The education level below primary school and women were the independent risk factors for cognitive impairment, and high serum creatinine concentration had a certain protective effect.