基于老年综合评估分析卒中恢复期老年患者认知衰弱发生及影响因素

Analysis of occurrence and influencing factors of cognitive frailty in elderly patients during recovery from stroke based on comprehensive geriatric assessment

目的调查卒中恢复期老年患者认知衰弱发生率并分析影响因素。方法采用便利抽样法,选取某三甲医院老年科卒中恢复期老年患者为研究对象,应用Frail量表、临床痴呆评定量表(CDR)判定患者的认知衰弱状况;采用二元Logistic回归分析影响卒中恢复期老年患者认知衰弱的因素,随机森林Boruta算法筛选影响认知衰弱的变量并进行排序。结果305名患者认知衰弱发生率为30.82%。年龄、血糖控制、吞咽障碍、首次发作卒中评分、康复锻炼、社会支持、自理能力等12个因素为卒中恢复期老年患者认知衰弱影响因素(P<0.05),随机森林对19个变量的重要性排序为:营养状况、社会支持、血糖控制、睡眠障碍、康复锻炼、首次发作卒中评分、血压控制、血脂控制、吞咽障碍、年龄、自理能力、文化程度。结论卒中恢复期老年患者认知衰弱发生率偏高,影响因素呈多元性,应针对性采取预防干预,以降低认知衰弱的风险。

Objective To investigate the incidence and influencing factors of cognitive frailty in elderly patients with stroke during recovery.Methods Convenience sampling was used to select the elderly stroke patients in the geriatrics department of a tertiary hospital as the subject.Frail scale and clinical dementia rating scale(CDR)were used to determine the cognitive frailty status of patients.Binary Logistic regression was used to analyze the factors affecting cognitive frailty in elderly patients with stroke recovery,and random forest Boruta algorithm was used to screen and rank the variables affecting cognitive frailty.Results The incidence of cognitive frailty in 305 patients was 30.82%.Twelve factors such as age,blood glucose control,dysphagia,first-attack stroke score,rehabilitation exercise,social support,and self-care ability were the influencing factors of cognitive frailty in elderly patients during the recovery period of stroke(P<0.05).The significance of 19 variables was ranked by random forest as follows:nutritional status,social support,blood glucose control,sleep disorder,rehabilitation exercise,first attack stroke score,blood pressure control,blood lipid control,dysphagia,age,self-care ability,education level.Conclusion The incidence of cognitive frailty in elderly patients during stroke recovery is high,and the influencing factors are diverse.Preventive interventions should be taken to reduce the risk of cognitive frailty.