老年综合评估与卒中后抑郁的相关性

Correlation Between Comprehensive Geriatric Assessment and Post-stroke Depression

目的分析老年综合评估(CGA)与卒中后抑郁(PSD)之间的相关性,分析卒中后抑郁的危险因素。方法选取2021年8月-2022年8月入住安徽医科大学附属宿州医院神经内科的急性缺血性老年卒中患者141例,根据患者卒中后是否罹患PSD分为PSD组与非PSD组;于患者卒中后1周和3个月进行老年综合评估,比较PSD组与非PSD组衰弱、睡眠、营养等相关老年资料的差异,采用多因素回归分析卒中后不同时期患者抑郁状态的危险因素。结果卒中后1周时PSD组有患者67例(47.52%),3个月61例(43.26%);在卒中后1周及3个月,PSD组和非PSD组美国国立卫生研究院卒中量表(NIHSS)评分、衰弱状态、微型营养评定表(MNA)评分、Tinetti量表评分、匹兹堡睡眠质量指数(PSQI)、社会支持评定量表(SSRS)评分比较,差异均有统计学意义(P<0.05),而两组年龄、BMI、Braden量表、简易智能精神状态检查量表(MMSE)、NRS疼痛评估评分、居家环境评分、性别、教育程度、饮酒、吸烟、共病评估、多重用药评估比较,差异均无统计学意义(P>0.05);多因素Logistic回归显示,非轻型卒中(OR=2.973,P=0.021)、衰弱状态(OR=3.363,P=0.019)、营养不良(OR=3.990,P=0.004)、平衡功能障碍或有跌倒危险(OR=5.369,P=0.001)、认知良好是卒中后1周PSD的独立危险因素,而社会支持良好(OR=0.318,P=0.011)有助于改善抑郁状态;非轻型卒中(OR=2.378,P=0.024)、衰弱状态(OR=3.869,P=0.001)及睡眠质量差(OR=3.311,P=0.003)是卒中后3个月PSD的独立危险因素。结论CGA与PSD相关,可以帮助早期识别老年卒中患者抑郁。

Objective To analyze the correlation between comprehensive geriatric assessment(CGA)and post-stroke depression(PSD),and to analyze the risk factors of post-stroke depression.Methods A total of 141 elderly patients with acute ischemic stroke admitted to the Department of Neurology,Suzhou Hospital Affiliated to Anhui Medical University from August 2021 to August 2022 were selected and divided into PSD group and non-PSD group according to whether they had PSD after stroke.Comprehensive geriatric assessment was performed at 1 week and 3 months after stroke.The differences of frailty,sleep,nutrition and other related geriatric data between PSD group and non-PSD group were compared.Multivariate regression analysis was used to analyze the risk factors of depression in patients at different stages after stroke.Results There were 67 patients(47.52%)in PSD group at 1 week after stroke and 61 patients(43.26%)at 3 months.At 1 week and 3 months after stroke,there were significant differences in National Institutes of Health Stroke Scale(NIHSS)score,frailty status,Mini Nutritional Assessment(MNA)score,Tinetti Scale Score,Pittsburgh Sleep Quality Index(PSQI)and Social Support Rating Scale(SSRS)score between PSD group and non-PSD group,and differences were statistically significant(P<0.05).There were no significant differences in age,BMI,Braden scale,mini-mental state examination(MMSE),NRS pain assessment score,home environment score,gender,education level,drinking,smoking,comorbidity assessment and polypharmacy assessment between the two groups(P>0.05).Multivariate logistic regression showed that non-mild stroke(OR=2.973,P=0.021),frailty(OR=3.363,P=0.019),malnutrition(OR=3.990,P=0.004),balance dysfunction or risk of falling(OR=5.369,P=0.001),and good cognition were independent risk factors for PSD at 1 week after stroke,while good social support(OR=0.318,P=0.011)helped to improve depression;non-mild stroke(OR=2.378,P=0.024),frailty(OR=3.869,P=0.001)and poor sleep quality(OR=3.311,P=0.003)were independent risk factors for PSD at 3 months after stroke.Conclusion CGA is associated with PSD and can help elderly stroke patients identify depression early.