急性缺血性卒中病人认知功能动态变化的初步研究  

A preliminary study on the dynamic changes of cognitive function in patiens after acute ischemic stroke

作　　者：陶带花 张千[1] 张兆[1] 李琳 徐耀[3] 张盛楠 李陈芳 徐俊 TAO Dai-hua;ZHANG Qian;ZHANG Zhao;LI Lin;XU Yao;ZHANG Sheng-nan;LI Chen-fang;XU Jun(Department of Neurology,First People’s Hospital of Nanning,Nanning 530022,China;Department of Neurology,Dongyang People’s Hospital,Jinhua 322100,China;Department of Neurology,Subei People’s Hospital of Jiangsu province,Yangzhou 225001,China;Department of Cognitive Impairment,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]南宁市第一人民医院神经内科一区,广西壮族自治区南宁市530022 [2]东阳市人民医院神经内科,浙江省金华市322100 [3]江苏省苏北人民医院神经内科,江苏省扬州市225001 [4]首都医科大学附属北京天坛医院神经病学中心认知障碍科(国家神经系统疾病临床医学研究中心),北京市100070

出　　处：《实用老年医学》2020年第7期640-643,648,共5页Practical Geriatrics

基　　金：国家自然科学基金(81870821,81471215,81271211);北京市青年拔尖团队(2018000021223TD08);江苏省社会发展重点病种规范化诊疗项目(BE2015665);江苏省自然科学基金(BK20151592)。

摘　　要：目的探讨急性缺血性卒中病人认知功能动态变化。方法前瞻性登记急性缺血性卒中病人291例,分别在梗死后2周内(基线)、3个月和6个月对病人进行认知功能和日常生活能力评估。结果共有151例急性缺血性卒中病人完成基线、3个月和6个月随访,其中老年组(>60岁)112例。卒中后认知障碍(poststroke cognitive impairment,PSCI)在卒中基线、卒中后3个月和卒中后6个月的发生率分别为55.6%、43.7%和41.7%。卒中后3个月和6个月的认知功能和日常生活能力评分均比基线时有所提高,差异有统计学意义(P<0.05);但卒中后6个月与卒中后3个月相比,差异无统计学意义。MoCA子项的动态变化各不相同。老年组在卒中基线时、卒中后3个月、卒中后6个月的PSCI发生率均高于非老年组,认知功能和日常生活能力评分均低于非老年组,差异有统计学意义(P<0.05)。结论急性缺血性卒中病人具有较高的PSCI发生率,老年急性缺血性卒中病人较年轻病人更易发生PSCI。在卒中后3个月,多数缺血性卒中病人认知功能较急性期有提高,尤其在命名、视空间与执行能力、注意力、延迟回忆方面改善明显。Objective To investigate the dynamic changes of cognitive function after acute ischemic stroke.Methods A total of 291 patients with acute ischemic stroke were prospectively registered.The assessment of cognitive function and daily living ability were performed within 2 weeks(baseline),3 months,and 6 months after infarction.Results A total of 151 patients,including 112 senile(>60 years-old),completed follow-up at baseline,3 months,and 6 months.The incidence rate of post-stroke cognitive impairment(PSCI)was 55.6%,43.7%,and 41.7%at baseline,3 months,and 6 months after stroke,respectively.The scores of cognitive function and daily living ability at 3 months and 6 months after stroke were improved compared with those at baseline.The scores at 6 months after stroke were slightly improved compared with 3 months after stroke,but there was no statistical difference.The dynamic changes of MoCA sub-items were different.The incidence rate of PSCI of senile group was higher than that of non-senile group,and the scores of cognitive function and daily living ability were worse than those in non-senile group at baseline,3 months and 6 months after stroke.Conclusions Patients with acute ischemic stroke have a higher incidence of PSCI,and the elderly are easier to have PSCI.At 3 months after stroke,most patients with ischemic stroke have improved cognitive function compared to the acute phase,especially in naming,visual space and executive ability,attention and delayed recall.

关 键 词：急性缺血性卒中 卒中后认知障碍 动态变化 

分 类 号：R749.1[医药卫生—神经病学与精神病学]