腔隙性脑梗死后抑郁伴认知障碍危险因素及认知损伤特征

Risk factors and characteristics of cognitive impairment associated with depression after lacunar cerebral infarction

目的探讨腔隙性脑梗死后抑郁伴认知障碍发生的危险因素及认知损伤特征。方法前瞻性连续选取2016—2019年收治的148例腔隙性脑梗死后抑郁患者,于入院后72 h之内完成核磁共振颅脑扫描,并于1周内应用简易精神状态评价量表(MMSE)对认知功能进行测评。结合临床和MMSE评分结果,将入选患者分为2组,脑梗死后抑郁伴认知障碍组45例(30.4%),其中男性29例,女性16例,年龄50~79岁,平均(64±7)岁;脑梗死后抑郁无认知障碍组103例(69.6%),其中男性55例,女性48例,年龄50~80岁,平均(62±7)岁。观察2组患者一般临床资料及梗死部位的分布特征,运用Logistic回归法分析腔隙性脑梗死后抑郁伴认知障碍发生的危险因素,在此基础上探讨腔隙性脑梗死后抑郁伴认知障碍患者认知损伤特征。结果①2组在受教育程度、吸烟史及高同型半胱氨酸血症之间差异有统计学意义(均P<0.05),在性别、年龄等一般资料间差异无统计学意义。②脑梗死后抑郁伴认知障碍组基底节区梗死灶患者的比例高于脑梗死后抑郁无认知障碍组,差异有统计学意义(P<0.01),其余脑区梗死灶患者的比例差异无统计学意义。③多因素Logistic回归分析结果显示:受教育程度[OR=0.186,95%CI(0.085,0.408),P<0.01]、吸烟史[OR=2.280,95%CI(1.030,5.046),P=0.042]、基底节区梗死[OR=3.774,95%CI(1.657,8.622),P=0.020]是腔隙性脑梗死后抑郁患者发生认知功能障碍的独立危险因素。④2组MMSE总分及在分项中的定向力、注意力和计算力、回忆能力及语言能力方面差异有统计学意义(均P<0.01)。结论受教育程度、吸烟史及基底节区梗死是腔隙性脑梗死后抑郁患者发生认知功能障碍的独立危险因素。腔隙性脑梗死后抑郁伴认知障碍患者可出现定向力、注意力和计算力、回忆能力以及语言能力的损伤。

Objective To investigate the risk factors and characteristics of cognitive impairment associated with depression after lacunar cerebral infarction. Methods Prospectively, 148 patients with depression after lacunar cerebral infarction admitted from 2016 to 2019 were selected consecutively. They completed MRI brain scan within 72 hours after admission and used the mini-mental state examination (MMSE) to assess cognitive function within one week. Combined with the clinical and MMSE scores, the enrolled patients were divided into two groups. There were 45 cases (30.4%) in the group of depression after cerebral infarction associated with cognitive impairment, including 29 men and 16 women, ranging in age from 50 to 79 years old, with an average age of (64±7) years. There were 103 cases (69.6%) in the group of post-cerebral infarction depression without cognitive impairment, including 55 males and 48 females, ranging in age from 50 to 80 years, with an average age of (62±7) years. We observe the general clinical data and the distribution characteristics of the infarction site of the two groups of patients, the risk factors for the occurence of depression with congitive impairment after lacunar cerebral infarction were analyzed by Logistic regression method, and on this basis, the cognitive impairment characteristics of patients with depression with cognitive impairment after lacunar cerebral infarction were discussed. Results ①There were statistically significant differences between the two groups in education level, smoking history and hyperhomocysteinemia (P<0.05), and there were no statistically significant differences in general data such as gender and age. ②The proportion of patients with basal ganglia infarction in the group with post-infarction depression and cognitive impairment was higher than that in the group without cognitive impairment, with significant statistical difference (P<0.01). ③The results of multivariate Logistic regression analysis showed that education level [OR=0.186, 95%CI(0.085, 0.408), P<0.01], smoking history [OR=2.280,95%CI(1.030, 5.046), P=0.042), basal node infarction [OR=3.774, 95%CI(1.657, 8.622), P=0.020) were independent risk factors for cognitive impairment in patients with lacunar cerebral infarction. ④There were statistically significant differences in the total MMSE scores and subitems of the two groups in the ability of directed attention, computational power, recall and language ability(P<0.01). Conclusion Education, smoking history and basal ganglia infarction were independent risk factors for cognitive impairment in patients with depression after lacunar cerebral in-farction. Patients with depression after lacunar cerebral infarction and cognitive impairment may have impairment of orientation, attention and computation, recall ability, and language ability.