急性脑梗死患者认知障碍与MRI表现

Cognitive impairment and MRI manifestation in patients with acute cerebral infarction

目的分析急性脑梗死(ACI)患者认知障碍与梗死灶的部位、体积、数目及伴随脑病理性改变的关系。方法纳入76例ACI患者,发病0~7d内进行相关检查,根据简明精神精神状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)评分分为认知正常、轻度认知障碍和痴呆组,比较三组梗死灶特点的差异。结果 76例患者中85.5%有不同程度认知损伤。与认知正常组相比,余两组教育年限短、发病前临床痴呆评定量表(CDR)高(P<0.05);其中轻度认知障碍组NHISS、改良Rankin量表(MRS)、Barthel指数(BI)均低于痴呆组(均P<0.05)。梗死灶位于左/右侧半球、是否涉及皮质及具体部位对认知障碍发病率没有影响,但梗死数目越多、体积越大,认知受损越明显。有认知受损者多伴脱髓鞘等脑改变。结论 ACI认知障碍有一定的特殊性,发病率较高,认知受损的程度与发病前认知水平、神经功能缺失程度、教育水平、梗死数目、梗死体积、一些伴随的脑病理性改变有关,与性别、年龄、梗死部位、涉及皮质损伤等无明显关系。

Objective To investigate the relationship between cognitive impairment and the location,volume,number of infarction and the pathological changes in patients with acute cerebral infarction(ACI).Method Data were collected in0-7d after ACI,According to the Mini Mental State Examination(MMSE),the MontrealCognitive Assessment Scale(MoCA)was divided into normal cognitive,mild cognitive impairment and dementiagroups,comparing the characteristics of this three groups.Results85.53%of76patients have different degree ofcognitive impairment.Compared with normal cognition group,other two groups had shorter education years and higherprior Dementia Rating Scale(CDR)(P<0.05).the NHISS,MRS,Barthel(BI)of mild cognitive impairment groupwere lower than those in the dementia group.The infarcts located in the left/right hemisphere,involving the cortexand specific location has no effect on the incidence of cognitive impairment,but the more number of infarction and thelager volume,the more obvious cognitive impairment.Patient have cognitive impairment are associated with cerebralhemorrhage,demyelination.Conclusion The cognitive impairment in ACI is particularity,with higher incidence,thedegree of cognitive impairment is associated with education levels,infarction number,infarct volume and some brainchanges,however associated little with gender,age,infarction area,involving cortex damage,etc.