卒中后认知功能特点和相关影响因素分析

Risk factors and characteristics of cognitive function in patients after stroke

目的:探讨卒中后认知功能特点及相关交互影响因素。方法:纳入住院治疗的脑卒中患者287例。使用简明精神状态量表(MMSE)进行认知功能筛查评定,同时使用自制问卷、改良Barthel指数(MBI)、中文版日常家居及社区活动能力量表(IADL)、焦虑/抑郁自评量表(SAS/SDS)对患者的个人情况、日常生活活动能力(ADL)等因素进行评估;最后分别以MMSE、ADL、SAS/SDS评分为因变量进行多元线性逐步回归分析。结果:287例患者中38.0%的卒中患者有不同程度的认知功能障碍。多元线性逐步回归显示高学历与卒中患者认知功能障碍呈负相关(P<0.05),高龄、言语功能障碍、单侧忽略以及右侧大脑损伤与卒中患者认知功能障碍呈正相关(均P<0.05);认知功能与患者抑郁、焦虑状态无相关性,但延迟回忆和语言功能与抑郁相关(均P<0.05);ADL与认知功能呈正相关(P<0.05),定向能力与日常生活活动能力呈正相关(P<0.05)。结论:卒中患者认知功能受损较常见,认知功能障碍与患者的年龄、受教育水平、疾病因素等多元因素相关,并影响患者的心理状态和日常生活活动能力;认知功能的各亚类中定向能力状态与患者的日常生活活动能力密切相关。

Objective:To investigate the risk factors and characteristics of cognitive function in patients after stroke.Methods:Stroke patients were enrolled from July 2021 to July 2022 in West China Hospital.The Mini-Mental State Examination(MMSE)was used to screen the cognitive function of the patients,and the self-made general questionnaire,Modified Barthel Index(MBI),Chinese Lawton IADL scale(IADL),Zung Self-rating Anxiety/Depression Scale(SAS/SDS)were used to evaluate the patients’personal conditions,activities of daily living and other factors.Then multiple linear regression analysis was performed with cognitive function scores,MBI and IADL scores,anxiety and depression scores as dependent variables.Results:A total of 287 patients were included in this study,and 38.0%of patients had varying degrees of cognitive impairment.Multiple linear stepwise regression showed that higher education level was a protective factor for cognitive dysfunction in stroke patients(P<0.05).Advanced age,speech dysfunction,unilateral neglect,and damage to the right side of the brain were risk factors for cognitive dysfunction in stroke patients(P<0.05).There was no correlation between cognitive function and depression and anxiety(P>0.05),but delayed recall and language function were associated with depression(P<0.05).Cognitive function was positively correlated with activities of daily living(ADL)ability(P<0.05),among which orientation ability was a protective factor for ADL(P<0.05).Conclusion:The related factors for cognitive dysfunction in stroke patients included age,education level,disease factors and other factors,cognitive function affects the patients’depression and ADL ability,and the orientation ability of each sub-type of cognitive function is closely related to the ADL of patients.