脑卒中老年患者记忆障碍的影响因素及其预测模型构建  

Influencing factors of memory impairment in elderly stroke patients and construction of prediction model

作　　者：费啸 高小夏[1] 张佳楠 恽晓萍 何泽佳 张瑜[1] 郭婧 谢凡 张一[1] Fei Xiao;Gao Xiaoxia;Zhang Jianan;Yun Xiaoping;He Zejia;Zhang Yu;Guo Jing;Xie Fan;Zhang Yi(Department of Rehabilitation Medicine,the First People's Hospital of Changzhou,Changzhou 213003,China;Department of Rehabilitation Assessment,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]常州市第一人民医院康复医学科,常州213003 [2]中国康复研究中心康复评定科,北京100068

出　　处：《中华老年医学杂志》2024年第9期1149-1154,共6页Chinese Journal of Geriatrics

基　　金：江苏省卫生健康委员会2022年度省老年健康科研项目(LKM2022051)。

摘　　要：目的探讨脑卒中老年患者记忆障碍的影响因素及其预测模型构建。方法选取常州市第一人民医院收治的100例脑卒中患者,蒙特利尔认知评估量表记忆指数(MoCA MIS)评估患者记忆障碍的发生情况,单因素和多因素Logistic回归分析脑卒中老年患者记忆障碍发生的影响因素,对相关量表评分进行相关性分析,并构建预测模型。结果49例无记忆障碍(49.0%)。记忆障碍组年龄>75岁者占比、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、美国国立卫生研究院卒中量表(NIHSS)评分较无记忆障碍组高,受教育年限>9年、高密度脂蛋白胆固醇(HDL-C)、简易精神状态检查(MMSE)评分、Rivermead行为记忆测试第2版(RBMT-Ⅱ)评分、基于图片的记忆障碍筛查(PMIS)评分较无记忆障碍组低(均P<0.05)。脑卒中记忆障碍患者MoCA-MIS评分与NIHSS评分、TG、LDL-C呈负相关(r=-0.394、-0.435、-0.494,均P<0.05),与HDL-C、MMSE评分、RBMT-Ⅱ评分、PMIS评分呈正相关(r=0.351、0.412、0.407、0.386,均P<0.05)。多因素Logistic回归分析结果显示,受教育年限、TG、HDL-C、NIHSS评分、MMSE评分、RBMT-Ⅱ评分、PMIS评分及病灶侧为皮层或颞叶是脑卒中患者记忆障碍的影响因素(均P<0.05)。受试者工作特征曲线(ROC)分析结果显示,预测模型预测脑卒中患者记忆障碍的曲线下面积(AUC)为0.955(95%CI:0.921~0.977),约登指数为0.841。结论脑卒中老年患者发生记忆障碍的风险与受教育年限和血脂水平等有关,高教育水平、积极认知功能和记忆训练是记忆障碍的保护因素,由影响因素构建的预测模型对脑卒中后记忆障碍发生的预测价值较高。ObjectiveTo examine the factors that contribute to memory impairment in elderly stroke patients and develop a predictive model.MethodsOne hundred stroke patients from the First People's Hospital of Changzhou were selected to assess the incidence of memory impairment using the Montreal cognitive assessment memory index score(MoCA-MIS).Univariate analysis and multivariate Logistic regression were performed to determine the factors influencing memory impairment in these patients.Additionally,the correlation among relevant scale scores was examined,and a prediction model was developed.ResultsIn the study,49 patients(49.0%)did not exhibit memory impairment.Patients with memory impairment were found to have higher proportions of individuals over 75 years old,elevated levels of triglyceride(TG),total cholesterol(TC),low-density lipoproteins cholesterol(LDL-C),and National Institute of Health Stroke Scale(NIHSS)scores compared to those without memory impairment.Conversely,patients without memory impairment had higher proportions of individuals with more than 9 years of education,higher levels of high-density lipoprotein cholesterol(HDL-C),mini-mental state examination(MMSE)scores,Rivermead behavioural memory test-Ⅱ(RBMT-Ⅱ)scores,and picture-based memory impairment screen(PMIS)scores(all P<0.05).Furthermore,Montreal cognitive assessment-memory index(MoCA-MIS)scores in stroke patients with memory impairment showed negative correlations with NIHSS scores,TG,and LDL-C,while showing positive correlations with HDL-C,MMSE scores,RBMT-Ⅱscores,and PMIS scores(all P<0.05).Multifactorial Logistic regression analysis indicated that years of education,TG,HDL-C,NIHSS score,MMSE score,RBMT-Ⅱscore,PMIS score,and the location of the lesion in the cortex or temporal lobe were significant factors influencing memory impairment in stroke patients(all P<0.05).The receiver operating characteristic curve(ROC)analysis revealed an area under curve(AUC)of 0.955(95%CI:0.921-0.977)for the prediction model of memory impairment in stroke patie

关 键 词：卒中 记忆障碍 简易精神状态量表 

分 类 号：R743.3[医药卫生—神经病学与精神病学]