缺血性脑卒中后认知功能障碍与梗死部位及体积的关系分析

Relationship between cognitive dysfunction and infarction area and area after cerebral infarction

目的:分析缺血性脑卒中后认知功能障碍和梗死部位及体积的关系。方法:选取2016年12月~2018年7月于东台市人民医院神经内科住院治疗的缺血性脑卒中患者共193例。在其脑梗死急性期和病程6个月时分别用简明精神状态检查量表(mini-mental state examination,MMSE)和蒙特利尔认知评定量表(montreal cognitive assessement,MoCA)进行认知的筛查和评估,结合入组标准,可分为合并认知障碍组95例和无认知障碍组98例。对所有患者均行头颅磁共振检查,比较分析两组患者头颅磁共振梗死部位及梗死体积,进一步分析两组患者的MoCA各个分项目(如视空间和执行功能、命名、注意力、语言的功能、抽象概括的能力、记忆力、定向力)的评分与梗死部位之间的关系,从而分析缺血性卒中后认知障碍与二者的关系。结果:合并认知障碍组及无认知障碍组的不同梗死部位发生的人数比较有着显著性的差异(P<0.05),合并认知障碍组出现多发性梗死的患者多于无认知障碍组。合并认知障碍组的梗死体积大于无认知障碍组,差异有统计学意义(P<0.05),合并认知障碍组中丘脑、额叶、颞叶、顶叶、枕叶、基底节部位的梗死体积大于无认知障碍组,差异有统计学意义(P<0.05)。视空间与执行功能评分在不同梗死部位之间存在显著性差异(P=0.021),其中额叶、海马评分偏低,顶叶、枕叶评分偏高;注意力评分在不同部位之间存在显著性差异(P=0.036),额叶和丘脑评分偏低,枕叶评分偏高;语言功能评分在不同部位之间存在显著性差异(P=0.018),颞叶和丘脑评分偏低;抽象概括能力评分在不同部位之间存在显著性差异(P=0.047),额叶评分偏低;记忆力评分在不同部位之间存在显著性差异(P=0.025),颞叶和海马评分偏低;命名能力、定向力评分在各个梗死部位间差异无统计学意义(P>0.05)。合并认知障碍组患者梗死体积与MoCA总分值呈负相关,差异有统计学意义(P<0.05),而无认知障碍组患者梗死体积与MoCA总分值无显著相关性(P>0.05)。结论:额叶、颞叶、顶叶、丘脑、基底节、海马部位的梗死较其他部位容易合并认知功能障碍,梗死部位不同,认知功能损伤特点不相同;梗死体积大的脑梗死容易合并认知功能障碍,认知障碍程度与脑梗死体积呈正相关。

Objective To investigate the relationship between cognitive dysfunction and infarct size and area after cerebral infarction.Method 193 patients with ischemic stroke were involved in our study, which were admitted to the department of neurology in Dongtai Municipal People, s Hospital from December 2016 to July 2018.Screen and assess the patients with mini-mental state examination(MMSE) and montreal cognitive assessement(MoCA) upon acute cerebral infarction and 6 month after cerebral infarction, which were divided into two groups.95 patients with cognitive impairment were taken as dementia group, and 98 patients without cognitive impairment were taken as non dementia group.The infarction sites and infarct volume between the two groups were compared by performing head magnetic resonance imaging.The relationship between the scores of MoCA(including visual acuity and executive function, naming, attention force, language function, abstraction ability, memory, orientation) and the infarct site was further analyzed.Results There was significant difference in the distribution of infarction between the dementia group and the non dementia group(P<0.05).The incidence of multiple infarction in dementia group was significantly higher than that in non dementia group(P<0.05).The infarct size in the dementia group was significantly greater than that in the non-dementia group(P< 0.05).The infarct volume in frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus and basal ganglia in the dementia group was significantly higher than that in the non dementia group(P<0.05);The visual acuity and executive function of frontal lobe, hippocampal cerebral infarction were significantly impaired compared with other sites(P=0.021);The scores of attention in frontal lobe and thalamic infarct patients were significantly impaired compared with other sites.(P=0.036);The language function scores of patients with temporal lobe and thalamic infarction were significantly impaired compaired with other sites(P=0.018);The abstract abilities of patients with frontal lobe infarction were more severely impaired than those with other lesions(P=0.047);The memory of patients with temporal lobe and hippocampal infarction was worse than that of other lesions(P=0.025).There was no significant difference in naming ability and orientation score between the temporal lobe, frontal lobe, parietal lobe, occipital lobe, thalamus, internal capsule and other infarct sites(P> 0.05).The infarct size in the dementia group was negatively correlated with the MoCA total score(P<0.05), but there was no significant correlation between infarct volume and total score of MOCA in patients without lognitive impairment(P>0.05). Conclusion The frontal lobe, temporal lobe, parietal lobe, thalamus and basal ganglia infarction are more likely to be associated with cognitive impairment, different infarction sites and different cognitive impairment characteristics.Large area cerebral infarction is easily associated with cognitive dysfunction.The degree of cognitive dysfunction was positively correlated with cerebral infarction.Ischemia stroke combine with cerebral microbleeds and white matter hyperintensities are more likely get dementia.