老年缺血性脑卒中患者社会网络与认知功能的相关性研究

Study on the relationship between social network and cognitive function in elderly patients with ischemic stroke

目的探讨老年脑卒中患者社会网络与认知功能及其各领域的相关性。方法采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(分为MES-M和MES-E)、语言功能量表(LAST)、社会网络量表(LSWS-6)对2018年8月-2019年5月复旦大学附属上海市第五人民医院收治的141例老年脑卒中患者进行评估;采用Pearson和Spearman相关对认知功能的影响因素进行单因素分析,基于社会网络影响健康结局的理论和单因素分析结果建立结构方程模型。结果研究对象中认知障碍与轻度认知障碍发生率分别为33.3%和94.3%。路径分析显示:年龄、婚姻状况、文化程度、有氧运动、抑郁状态、神经功能缺损评分(NIHSS)等直接和(或)间接影响老年患者认知功能,社会网络在文化程度与MMSE、MoCA、MES-M之间起中介作用,中介效应值分别为0.047、0.065、0.092,社会网络在抑郁状态与MMSE之间的中介效应值为-0.105。结论脑卒中后认知障碍在老年缺血性脑卒中患者中十分常见,受多种因素影响,抑郁状态和社会网络均对认知功能有显著影响,社会网络在抑郁状态与认知功能之间起中介作用。医护人员及其照顾者应注意加强老年患者社会交往活动,以延缓脑卒中后认知障碍进展过程。

Objective To explore the correlation between social networks and cognitive function and its domains in elderly patients with stroke.Methods Mini mental state examination scale(MMSE),Montreal cognitive assessment scale(MoCA),memory and execution screening scale(including MES-M and MES-E),and language function scale(LAST)and lubben social network scale-6(LSWS-6)were used to evaluate 141 elderly patients with stroke in a tertiary hospital in Shanghai from August 2018 to May 2019.Pearson's and Spearman's correlation were used to perform the single factor analysis of the influencing factors of cognitive function.A structural equation model was established based on the theory of social networks affecting health outcomes and results of single factor analyses.Results The incidence of cognitive impairment and mild cognitive impairment in the study was 33.3%and 94.3%respectively.The path analysis showed that age,marriage,degree of education,aerobic exercise,depressive state,NIHSS score,etc.,which directly and/or indirectly affect the cognitive function of elderly patients.The mediating effects of social networks between education level and MMSE,MoCA,MES-M,and the mediating effect values were 0.047,0.065,and 0.092 respectively.The mediating effect value of social networks between depression and MMSE was-0.105.Conclusion Post-stroke cognitive impairment is very common in elderly patients with ischemic stroke,which is affected by many factors.Depression and social networks have significant effects on cognitive function and social networks play as a mediating role between depression and cognitive function.Doctors,nurses and caregivers should pay attention to strengthen social activities of elderly patients to delay the development of cognitive impairment after stroke.