急性缺血性卒中病人认知功能动态变化的初步研究

A preliminary study on the dynamic changes of cognitive function in patiens after acute ischemic stroke

目的探讨急性缺血性卒中病人认知功能动态变化。方法前瞻性登记急性缺血性卒中病人291例,分别在梗死后2周内(基线)、3个月和6个月对病人进行认知功能和日常生活能力评估。结果共有151例急性缺血性卒中病人完成基线、3个月和6个月随访,其中老年组(>60岁)112例。卒中后认知障碍(poststroke cognitive impairment,PSCI)在卒中基线、卒中后3个月和卒中后6个月的发生率分别为55.6%、43.7%和41.7%。卒中后3个月和6个月的认知功能和日常生活能力评分均比基线时有所提高,差异有统计学意义(P<0.05);但卒中后6个月与卒中后3个月相比,差异无统计学意义。MoCA子项的动态变化各不相同。老年组在卒中基线时、卒中后3个月、卒中后6个月的PSCI发生率均高于非老年组,认知功能和日常生活能力评分均低于非老年组,差异有统计学意义(P<0.05)。结论急性缺血性卒中病人具有较高的PSCI发生率,老年急性缺血性卒中病人较年轻病人更易发生PSCI。在卒中后3个月,多数缺血性卒中病人认知功能较急性期有提高,尤其在命名、视空间与执行能力、注意力、延迟回忆方面改善明显。

Objective To investigate the dynamic changes of cognitive function after acute ischemic stroke.Methods A total of 291 patients with acute ischemic stroke were prospectively registered.The assessment of cognitive function and daily living ability were performed within 2 weeks(baseline),3 months,and 6 months after infarction.Results A total of 151 patients,including 112 senile(>60 years-old),completed follow-up at baseline,3 months,and 6 months.The incidence rate of post-stroke cognitive impairment(PSCI)was 55.6%,43.7%,and 41.7%at baseline,3 months,and 6 months after stroke,respectively.The scores of cognitive function and daily living ability at 3 months and 6 months after stroke were improved compared with those at baseline.The scores at 6 months after stroke were slightly improved compared with 3 months after stroke,but there was no statistical difference.The dynamic changes of MoCA sub-items were different.The incidence rate of PSCI of senile group was higher than that of non-senile group,and the scores of cognitive function and daily living ability were worse than those in non-senile group at baseline,3 months and 6 months after stroke.Conclusions Patients with acute ischemic stroke have a higher incidence of PSCI,and the elderly are easier to have PSCI.At 3 months after stroke,most patients with ischemic stroke have improved cognitive function compared to the acute phase,especially in naming,visual space and executive ability,attention and delayed recall.