重视卒中后远隔脑区继发性损害与认知障碍

Pay attention to secondary neurodegeneration in remote regions after stroke and cognitive impairment

卒中后认知障碍(post-stroke cognitive impairment,PSCI)严重影响患者神经功能恢复和生存质量,其发生机制、临床评估和干预已成为国内外卒中研究的热点。大量研究结果证实卒中后缺血未波及的认知相关脑区继发性损害是造成PSCI的机制之一。在啮齿类动物中发现这些远隔认知相关脑区β-淀粉样蛋白沉积和神经元丢失参与认知障碍的发生,减轻这些继发性损害可改善认知功能;非人灵长类动物实验研究发现卒中后远隔脑区有神经元丢失,却未发现β-淀粉样蛋白沉积;临床影像学研究也发现这些远隔脑区的继发性损害与认知功能的关联性,但与β-淀粉样蛋白沉积的关系并不明确。由于远隔脑区继发性损害发生时间相对较晚,且有更宽的治疗时间窗,对其行干预保护有望成为PSCI治疗的新靶点,具有重要的临床意义。

Post-stroke cognitive impairment(PSCI)seriously affects neurological recovery and quality of life of patients.Its mechanism,clinical evaluation,intervention have become research hotspot at home and abroad.Many studies have confirmed that secondary neurodegeneration in remote cognitive-related brain not affected by ischemia after stroke is one of the mechanisms of PSCI.It has been found in rodents thatβ-amyloid deposition and neuron loss in distant cognitive-related brain regions are involved in the occurrence of cognitive dysfunction and reducing these secondary damages can improve cognitive function.Experiments involving non-human primates have found neuronal loss but noβ-amyloid deposition in distant brain regions after stroke.Clinical studies have found associations between secondary neurodegeneration in remote regions and cognitive function by using neuroimaging techniques,but the relationship between PSCI andβ-amyloid deposition is not clear now.Due to its late occurrence time and wider therapeutic time window,its intervention treatment is expected to alleviate cognitive impairment,which has great clinical significance.