缺血性卒中后认知功能障碍的患病率和危险因素  

The prevalence and risk factors for cognitive impairment following ischemic stroke

作　　者：徐群[1] 林岩[1] 耿介立[1] 李红伟[1] 陈莺[1] 李焰生[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经内科,200127

出　　处：《中华内科杂志》2008年第12期981-984,共4页Chinese Journal of Internal Medicine

基　　金：上海市科委重大攻关课题（03DZ19704）

摘　　要：目的明确卒中后认知功能障碍（PSCI）的患病率和危险因素。方法526例缺血性卒中患者被分为无认知障碍、认知障碍非痴呆（CIND）和血管性痴呆（VaD），根据影像学表现，患者分为皮质下缺血性血管病、皮质型缺血性血管病和其他类型，登记患者人口学、血管危险因素和卒中病情等。结果PSCI患病率36．7％。与无认知障碍相比，PSCI患者年龄大、女性比例高、教育程度低、右侧瘫痪多、抑郁评分高，但血管危险因素无差别。与无认知障碍者相比，VaD者经济水平低、配偶照料少、失语多、尿失禁多、皮质型缺血性血管病多；CIND者则有较多的皮质下缺血性血管病。VaD者较CIND者皮质型缺血性血管病多、抑郁评分低。高龄、女性、低社会经济水平、失语、皮质下缺血性血管病、皮质型缺血性血管病和抑郁评分高为PSCI的独立危险因素。结论PSCI常见于缺血性卒中患者，与人口学因素、卒中类型及抑郁有关。Objectives To identify the prevalence and risk factors that were associated with post- stroke cognitive impairment （PSCI） among a large cohort of consecutive ischemic stroke patients. Methods 526 consecutive patients, who had suffered from ischemic stroke 3 months ago were recruited in this study. Patients were classified as having no cognitive impairment （ NCI）, cognitive impairment but no dementia （CIND） and vascular dementia （VaD） according to their cognitive function. They were also categorized as with subcortical ischemic vascular diseases （SIVD） or cortical isehemic vascular diseases （CIVD） with neuroimaging findings. Their demographic data, vascular risk factors and stroke characteristics were also documented. Results The overall prevalence of PSCI（ CIND ＋ VaD） was 36.7%. Compared with the NCI subjects, PSCI subjects were older, more dominant femininely, less educated, with more cases of right hemi-paralysis and higher depression scores, but did not have more specific vascular risk factor. Separately, VaD patients demonstrated lower economic level, less spouse-caring, more prevalence of dysphasia, higher rate of incontinence and more cases with CIVD, while CIND patients had more cases with SIVD. The VaD patients had more cortical lesions and lower depression scores than the CIND patients. On logistic regression analysis, older age, female gender, lower economic level, dysphasia, SIVD, CIVD and higher depression scores were independent risk factors for PSCI. Conclusion PSCI is common among ischemic stroke patients and related to demographic factors, stroke types, and depression.

关 键 词：认知障碍 痴呆 血管性 卒中 

分 类 号：R686[医药卫生—骨科学]