老年动脉瘤性蛛网膜下腔出血患者认知障碍的临床特点

Clinical characteristics of cognitive impairment in elderly with aneurysmal subarachnoid hemorrhage

目的探讨老年动脉瘤性蛛网膜下腔出血(a SAH)患者认知损害的特点及相关危险因素。方法入选2012年12月至2017年12月期间顺义区医院和首都医科大学附属北京天坛医院收治的老年a SAH患者共106例作为a SAH组,收集同期在神经内科门诊就诊的正常患者120例作为对照组。a SAH组患者分别于入院,出院,出院后3、6及12个月时进行神经心理学量表测定,对照组患者就诊时行神经心理学量表测评。应用北京版简明精神状态检查(MMSE)量表进行认知功能评估,同时应用修订版长谷川智能量表和痴呆简易筛选量表进行校正。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。采用多因素logistic回归分析筛选独立危险因素。结果 a SAH组与对照组的MMSE量表评分差异具有统计学意义[(23.51±1.20) vs (27.01±3.72)分,P<0.05]。a SAH患者出院3个月时的认知损害发生率最高,执行能力、言语理解及表达力、言语命名能力、言语复述、注意力及计算力和短程记忆力亚项得分最低。多因素logistic回归分析结果显示,动脉瘤的干预方式(OR=1.667,95%CI 0.567～6.468;P=0.027)、H分级(OR=1.126,95%CI 0.518～2.755;P=0.002)和Fish分级(OR=1.297,95%CI 0.477～1.982;P=0.028)与认知损害显著相关。结论 a SAH后的认知损害多在发病后3个月内较明显,主要表现在言语、执行能力、注意力、计算力及短程记忆力方面,临床上应重视Fish分级和H分级的评估,早期识别认知损害的高危人群并进行早期干预可改善预后。

Objective To investigate the characteristics of cognitive impairment and related risk factors in elderly patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 106 elderly patients with aSAH admitted to Shunyi District Hospital and Tiantan Hospital in Beijing from December 2012 to December 2017 were recruited and assigned to the aSAH group,and 120 normal patients in Neurology Outpatient Department during the same period were collected as the control group.The patients in aSAH group were assessed with neuropsychological scales at admission,discharge,and 3,6 and 12 months after discharge,and those in control group were assessed with neuropsychological scales at consultation.The cognitive function was assessed by the Beijing version of the mini-mental state examination(MMSE)scale,and corrected by the revised Hasegawa intelligence scale and the simple screening scale for dementia.SPSS statistics 17.0 was used for data processing.According to the data type,Chi-square test or Student′s t test was employed for comparison among groups.Multivariate logistic regression analysis was applied to screen independent risk factors.Results There was significant difference in the scores of MMSE between aSAH group and control group[(23.51±1.20)vs(27.01±3.72),P<0.05].The highest incidence of cognitive impairment was observed in the aSAH group in 3 months after discharge,with the lowest scores in the items such as executive ability,verbal comprehension and expressiveness,verbal naming ability,verbal retelling,attention and computational power,and short-term memory.Multivariate logistic regression analysis showed that the interventions(OR=1.667,95%CI 0.567-6.468;P=0.027),H-grade(OR=1.126,95%CI 0.518-2.755;P=0.002)and Fish-grade(OR=1.297,95%CI 0.477-1.982;P=0.028)of aneurysms were significantly correlated with cognitive impairment in the elderly.Conclusion Cognitive impairment after aSAH is more obvious in 3 months after onset,mainly in speech,executive ability,attention,calculation ability and short-term memory.Emphases should be paid in the evaluation of Fish and H grading in clinical practice.Early recognition of high-risk patients and early intervention for cognitive impairment can improve prognosis.