多发性脑梗死患者并发血管性帕金森综合征对认知功能的影响

Multiple cerebral infarction complicated with vascular Parkinsonism on cognitive function in patients

目的分析多发性脑梗死患者并发血管性帕金森综合征(Vascularparkinsonism,VaP)对认知功能的影响,为临床上多发性脑梗死并发VaP的诊治提供理论基础。方法选取宁德师范学院附属宁德市医院2020年1月至2022年1月收治的多发性脑梗死患者206例,根据是否并发VaP分为VaP组(n=58)和对照组(n=148),采用蒙特利尔认知评估量表(MoCA)评价患者认知功能,该量表包括注意与集中、执行功能、记忆、语言、视结构技能、抽象思维、计算和定向力等8个认知领域,采用Pearson单因素分析多发性脑梗死患者发生VaP与MoCA评分的相关性,比较两组年龄、性别、教育年限、脑白质病变及合并糖尿病、冠心病等血管危险因素,采用多元线性回归分析影响多发性脑梗死发生VaP的独立危险因素。结果VaP组MoCA评分明显低于对照组(P<0.05);具体到每个条目,VaP组注意与集中、记忆、语言和计算评分明显低于对照组(P<0.05);经Pearson相关性分析,注意与集中、记忆、语言和计算评分与多发性脑梗死患者发生VaP存在相关关系(r=-0.475,-0.314,-0.302,-0.389,P<0.05);脑白质病变、病灶部位在左半球和额叶、合并糖尿病、颈动脉斑块两两组间比较差异有统计学意义(P<0.05);脑白质病变(OR=2.571)、糖尿病(OR=2.369)和病灶部位在左半球(OR=2.958)是多发性脑梗死患者发生VaP的独立危险因素(P<0.05)。结论多发性脑梗死发生VaP的风险较高,与患者认知功能相关,对于合并脑白质病变、糖尿病及病灶部位在左半球的患者,应给予脑功能训练等早期干预。可明显改善患者认知功能,降低VaP的发生。

thinking,calculation and orientation.Pearson was used to analyze the correlation between VaP and MoCA score in patients with multiple cerebral infarction.Age,sex,years of education,white matter disease,diabetes mellitus,coronary heart disease and other vascular risk factors were compared between the two groups.The independent risk factors for VaP in multiple cerebral infarction were analyzed by multiple linear regression.Results MoCA score in VaP group was significantly lower than that in control group(P<0.05).In terms of each item,scores of attention and concentration,memory,language and computation in VaP group were significantly lower than those in control group(P<0.05).Pearson correlation analysis showed that attention and concentration,memory,language and computational scores were correlated with VaP in patients with multiple cerebral infarction(r=-0.475,-0.314,-0.302,-0.389,P<0.05).There were statistically significant differences between the two groups in white matter lesions,lesion sites in left hemisphere and frontal lobe,diabetes mellitus and carotid artery plaque(P<0.05).White matter lesions(OR=2.571),diabetes mellitus(OR=2.369)and lesion location in the left hemisphere(OR=2.958)were independent risk factors for VaP in patients with multiple cerebral infarction(P<0.05).Conclusion The risk of VaP in multiple cerebral infarction is high,which is related to the cognitive function of patients.Early intervention such as brain function training should be given to patients with white matter lesions,diabetes and lesions in the left hemisphere,can significantly improve patients′cognitive function and reduce the occurrence of VaP.