文字书写与卒中后认知功能障碍相关性临床研究

Correlative clinical study of writing and post-stroke cognitive impairment

目的探讨脑梗死患者卒中后认知功能和卒中前汉语语言输入情况之间的关系,并评估卒中后认知功能障碍患者的书写功能。方法(1)选取于2015年11月-2017年2月在同济大学附属第十人民医院神经内科住院并明确诊断为脑梗死的患者196例,按照MMSE量表标准将患者分为认知功能障碍组和认知功能正常组,比较两组患者的各项量表得分情况以及卒中前书写、阅读、电子产品使用情况,分析卒中后认知功能与卒中前汉语语言输入情况之间的关系,进一步分析书写能力与认知各个领域的相互关系以及变化的趋势;(2)用汉语失写检查法对患者进行书写功能的评估,分为书写正常组和书写障碍组,进一步分析书写功能与认知功能之间的关系,以及CAB各项得分情况;(3)将患者随机分为书写训练组和非书写训练组,在书写训练后的1 m、3 m、6 m再次进行认知功能和神经功能评估,分析书写训练对认知功能障碍和神经功能恢复的影响。结果(1)卒中后MMSE总分以及MOCA视空间、语言、记忆力等认知域分值与卒中前书写、阅读习惯之间呈现显著正相关(P<0.05),而与手机电脑使用时限无相关性(P≥0.05);(2)卒中后患者书写当中的听写、看图书写、自主书写分值与MMSE总分以及MOCA的视空间、记忆力、语言、注意力分之间呈正相关(P<0.05);(3)书写训练与3 m、半年后认知功能评分之间呈正相关性(P<0.05),书写训练与神经功能恢复无显著相关性(P>0.05)。结论发现卒中前书写、阅读习惯与卒中后较好的认知功能表现相关,发病前良好的汉字书写、阅读习惯可能对卒中后认知功能具有保护作用;卒中后书写水平与卒中后认知功能水平呈正相关,提示卒中后书写能力可能影响卒中后认知功能水平;书写训练可能对卒中后认知功能障碍有改善作用。

Objective Our study aimed to investigate the relationship between post-stroke cognitive function and prestroke Chinese language input in patients with cerebral infarction,and to assess the writing function of patients with post-stroke cognitive impairment.Methods(1)A total of 196 patients diagnosed with cerebral infarction were selected.Scores of various diagnostic scales,as well as writing,reading and use of electronic products before stroke were compared.The correlation between post-stroke cognitive function and pre-stroke Chinese language input,and the relationship between writing ability with cognition in various domains as well as the trend of changes were analyzed.(2)Chinese character writing training was used to analyze the prevention of post-stroke cognitive impairment and restoration of neurological function.Aphasia battery of Chinese(ABC)was used to assess the writing function of patients.Furthermore,the relationship between writing and cognitive functions,and the ABC scores were analyzed.(3)Patients’cognitive and neurological functions were evaluated again at 1 st,3 rd and 6 th months after writing training to analyze the effect of writing training on the cognitive impairment and neurological function recovery.Results(1)The total MMSE score and total Mo CA score were significantly correlated with the writing and reading of Chinese characters in pre-stroke patients(all P<0.05),but were not significantly correlated with the use limit of electronic products.(2)Total score of MMSE was significantly correlated with transcribing,dictating,graph writing,and active writing(all P<0.05),while the total score of Mo CA only had a significant positive correlation with the dictating,graph writing,and active writing(all P<0.05).(3)The total MMSE score at the 3 rd and 6 th months were significantly increased(both P<0.05).Conclusions Pre-stroke writing and reading habits were associated with better post-stroke cognitive performance,whereas good pre-stroke writing and reading habits might have a protective effect on post-stroke cognitive function.There was a positive correlation between the level of post-stroke writing and the level of post-stroke cognitive function,suggesting that the post-stroke writing ability may affect the level of poststroke cognitive function.Writing training might improve cognitive impairment after stroke.