非关键部位脑梗死患者的认知功能损伤研究  

Cognitive Impairment in Stroke Patients with Non-strategic Infarcts

作　　者：王展[1] 洪霞[2] 魏镜[2] 高山[2] 李舜伟[2] 

机构地区：[1]北京市首都医科大学附属北京天坛医院神经内科,100050 [2]中国医学科学院北京协和医院神经内科

出　　处：《中国卒中杂志》2009年第3期194-200,共7页Chinese Journal of Stroke

摘　　要：目的研究单次或两次非关键部位脑梗死（包括皮质下梗死和脑干小脑梗死）的患者其认知功能表现与正常对照之间的差异，了解非关键部位脑梗死患者认知功能受损情况。方法选取符合入组标准的、性别、年龄和受教育年数一一匹配的单次或两次发病的非关键部位脑梗死后5～6个月的患者和正常对照各30例，进行日常生活自理能力量表（ADL）、Hamilton抑郁量表17项评分（HAMD-17）、简易精神状态检查法（MMSE）、加利福尼亚词语学习（CVLT）、逻辑记忆（LM）、复杂图形（FC）、词语流畅性（VF）、结构实例（CP）、数字广度（DS）的评定。结果卒中组患者MMSE总分显著低于对照组（2．7．8±2．4 vs 28．9±0．9，P=0．021）；在CVLT总分、VF、认知总分方面与对照组相比存在统计学差异（38．2±7．0 vs 43．1±8．0，P=0．016；43．8±10．6 vs 53．6±11．3，P=0．001；168．3±24．0 vs 188．8±25．4，P=0．002），而在FC、LM、CP、DS方面两组相比没有统计学差异（41．2±7．1 vs 43.4±5．5，P=0．185；21．6±5．6 vs 24．1±5．1，P=0．078；11．0 vs 11．0，P=0．775；13．0±2．4 vs 13．9±2．8，P=0．171）。另外卒中组ADL和HAMD-17的得分显著高于对照组（26±9 vs 20±0，P=0．001；2．00 vs0．00，P=0．000）。结论单次或两次非关键部位脑梗死的患者存在一定的认知功能障碍，主要表现为词语记忆和执行功能方面，尤其以执行功能为著。Objective To investigate the characters of cognitive impairment in patients with non-strategic infarcts（including subcortex, brain stem and cerebellar infarction） for once or twice in compared with healthy people. Methods We recruited 30 patients being at 3-6 months after stroke and 30 healthy volunteers matching by age, gender and education level. Cognition was assessed by neuropsychological tests, including mini-mental state examination（MMSE）, California verbal learning test （CVLT）, logical memory（LM）, figure complex（FC）, verbal fluency（VF）, constructional praxis（CP）, digit span（DS） and was compared between patients and controls as well as ability of daily living （ADL） and Hamilton rating scale for depression- 17（HAMD- 17）. Results In comparison with controls, the stroke patients had significantly lower scores in MMSE（27.8±2.4 vs 28.9±0.9, P=0.021）, also in the total score of the cognition（168.3±24.0 vs 188.8 ±25.4, P=0.002）, CVLT（38.2±7.0 vs 43.1±8.0, P=0.016）and VF（43.8±10.6 vs 53.6±11.3, P=0.001）. However, the patients＇ performances in FC（41.2±7.1 vs 43.4±5.5, P=0.185）, LM（21.6±5.6 vs 24.1±5.1, P=0.078）, CP（Mann-Whitney Test, 11.0 vs 11.0, P=0.775） and DS（13.0±2.4 vs 13.9±2.8, P=0.171） were not significantly more impaired when compared with controls. The scores ofADL（26±9 vs 20±0, P=0.001） and HAMD-17（2.00 vs 0.00, P=0.000） were higher in the patients than in the controls. Conclusion Cognitive impairment of patients with non-strategic infarcts, compared with healthy volunteers, have been revealed, especially in the verbal memory and executive function, especially in executive function.

关 键 词：脑梗塞 非关键部位 认知障碍 词语记忆 执行功能 

分 类 号：R749.1[医药卫生—神经病学与精神病学]