老年短暂性脑缺血发作和小卒中患者认知障碍的特点及预后

Characteristics and outcome of transient ischemic attack and cognitive impairment in minor stroke patients

目的探讨老年短暂性脑缺血发作(TIA)和小卒中患者认知障碍的临床特点及预后。方法前瞻性收集2015年1月~2017年3月在本院确诊的老年TIA和小卒中患者115例,分为非认知障碍组55例及非痴呆性血管认知障碍(VCIND)组60例,随访1、3及6个月,比较患者临床特点和蒙特利尔认知评估量表(MoCA)评分及预后。结果 VCIND组血浆同型半胱氨酸水平较非认知障碍组明显升高[(23.38±3.31)μmol/L vs(17.21±2.10)μmol/L,P<0.01]。非认知障碍组MoCA总分(27.46±1.21)分,VCIND组MoCA总分(22.12±2.09)分,2组比较差异有统计学意义(P<0.05)。VCIND组视空间与执行能力、延迟回忆、语言复述、抽象能力评分低于非认知障碍组(P<0.05,P<0.01)。VCIND组1、3及6个月随访时,认知改善率分别为8.3%、33.3%和61.7%,差异有统计学意义(P<0.05)。结论老年TIA和小卒中患者的认知损害主要表现在视空间与执行能力、延迟回忆、语言复述、抽象能力方面,且随着时间推移,患者的认知损害会有所改善。

Objective To investigate the clinical characteristics and prognosis of cognitive impairment with transient ischemic attack（TIA）/minor stroke in elderly patients.Methods 115 elderly patients with TIA/minor stroke were enrolled prospectively from January 2015-March 2017,It is divided into two groups,including Non cognitive impairment group（55 cases）and non dementia vascular cognitive impairment（VCIND）group（60 cases）,following for 1,3 and 6 months,compared the clinical characteristics and the score of Montreal cognitive assessment（MoCA）scale.Results The plasma homocysteine level in VCIND group was significantly higher than non cognitive impairment group[（23.38±3.31）μmol/l vs（17.21±2.10）μmol/l,P〈0.01].The total MoCA score in non cognitive impairment group was 27.46±1.21,VCIND group was 22.21±2.09,the differences between the two groups were statistically significant（P〈0.05）.The average score of visual space/executive ability,delayed memory,language and abstract ability in VCIND group was lower than non cognitive impairment group（P〈0.05,P〈0.01）.1,3 and 6 months follow-up of group VCIND,The rate of cognitive improvement was 8.3%,33.3% and61.7%（P〈0.05）.Conclusion cognitive impairment in elderly patients with TIA and minor stroke is mainly manifested in the visual space/executive ability,delayed recall,language fluency/repetition and abstraction,the cognitive impairment of patients will improve over time.