认知储备对脑卒中患者认知障碍的预测作用

Role of cognitive reserve in predicting cognitive impairment in stroke patients

目的探讨认知储备对急性缺血性脑卒中(AIS)患者认知障碍的预测作用。方法于2021年11月至2022年10月,采取便利抽样法选择海军军医大学(第二军医大学)第一附属医院脑血管病中心和中国人民解放军东部战区空军医院卒中中心收治的291例AIS患者作为调查对象。使用认知储备指数问卷和蒙特利尔认知评估量表分别评估患者的认知储备和认知功能。一般资料调查通过患者的住院病历或神经科医师的床旁评估获得。采用多因素二元logistic回归模型分析认知储备对AIS患者认知障碍的预测作用。结果291例AIS患者的年龄为(65.9±10.4)岁,入院时美国国立卫生研究院卒中量表(NIHSS)评分为5(2,10)分,认知储备总分为(97±16)分,认知功能总分为23(17,27)分,发生认知障碍的患者有218例(74.9%)。在校正了年龄、户口类型、入院时NIHSS评分、糖尿病、大血管狭窄度和抑郁情绪后,认知储备是卒中后认知障碍的保护因素,高认知储备水平的AIS患者发生认知障碍的可能性是低认知储备水平患者的0.156倍(95%CI 0.045~0.538,P=0.003),中等认知储备水平的AIS患者发生认知障碍的可能性是低认知储备水平患者的0.272倍(95%CI 0.113~0.654,P=0.004)。结论较高水平的认知储备是AIS患者认知障碍的保护因素,提高认知储备水平有望成为脑卒中患者早期认知干预的潜在策略之一。

Objective To explore the role of cognitive reserve in predicting cognitive impairment in patients with acute ischemic stroke(AIS).Methods From Nov.2021 to Oct.2022,a total of 291 AIS patients admitted to Neurovascular Center of The First Affiliated Hospital of Naval Medical University(Second Military Medical University)and Stroke Center of Air Force Hospital of PLA Eastern Theater Command were selected by convenience sampling method.Cognitive reserve and cognitive function were assessed using cognitive reserve index questionnaire and Montreal cognitive assessment,respectively.General information was obtained from the patients’medical records or bedside assessment by neurologists.Multivariate binary logistic regression was used to analyze the predictive effect of cognitive reserve on cognitive impairment in AIS patients.Results The average age of 291 AIS patients was(65.9±10.4)years old.The National Institutes of Health stroke scale(NIHSS)score at admission was 5(2,10),the total scores of cognitive reserve and cognitive function were 97±16 and 23(17,27),respectively,and 218 patients(74.9%)had cognitive impairment.After adjusting for age,type of residency,NIHSS score at admission,diabetes mellitus,degree of cerebral vascular stenosis,and depression symptom,cognitive reserve was a protective factor for post-stroke cognitive impairment;AIS patients with high cognitive reserve level were 0.156 times more likely to have cognitive impairment than those with low cognitive reserve level(95%confidence interva[CI]0.045-0.538,P=0.003)and patients with moderate level of cognitive reserve were 0.272 times more likely to have cognitive impairment than those with low cognitive reserve level(95%CI 0.113-0.654,P=0.004).Conclusion A higher level of cognitive reserve is a protective factor for AIS patients with cognitive impairment.Improving the level of cognitive reserve is expected to be one of the potential strategies for early cognitive intervention in stroke patients.