急性缺血性脑卒中后患者认知功能障碍的相关因素研究
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摘要
目的研究急性缺血性脑卒中后患者认知功能障碍(PSCI)发生的相关因素。方法收集住院急性期缺血性脑卒中患者288例,根据简易智力状态检查(MMSE)量表评分将入组患者分为PSCI组和非PSCI组,比较两组患者的临床资料,分析PSCI的可能相关影响因素。结果本研究PSCI的总发病率为53. 1%,Logistic回归分析显示,高龄、脑梗死病史、发病部位是PSCI发病的危险因素。结论急性缺血性脑卒中后PSCI常见,高龄、脑梗死病史、发病部位是PSCI发病的危险因素。
Aim To investigate the influencing factors of cognitive impairment in patients after ischemic stroke. Methods 288 hospitalized patients with acute ischemic stroke were collected. According to the Mini-mental State Examination scale,the patients were divided into two groups: a post-stroke cognitive impairment( PSCI) group and a post-stroke non-cognitive impairment( nPSCI) group. The case data of the two groups were compared and the related factors of PSCI were analyzed. Results The overall incidence of PSCI in this study was 53. 1%. Logistic regression analysis showed that age,history of cerebral infarction and location of onset were risk factors for PSCI. Conclusion Cognitive impairment is common in patients with acute ischemic stroke. Age,history of cerebral infarction and location of onset are risk factors for cognitive impairment after stroke.
Aim To investigate the influencing factors of cognitive impairment in patients after ischemic stroke. Methods 288 hospitalized patients with acute ischemic stroke were collected. According to the Mini-mental State Examination scale,the patients were divided into two groups: a post-stroke cognitive impairment( PSCI) group and a post-stroke non-cognitive impairment( nPSCI) group. The case data of the two groups were compared and the related factors of PSCI were analyzed. Results The overall incidence of PSCI in this study was 53. 1%. Logistic regression analysis showed that age,history of cerebral infarction and location of onset were risk factors for PSCI. Conclusion Cognitive impairment is common in patients with acute ischemic stroke. Age,history of cerebral infarction and location of onset are risk factors for cognitive impairment after stroke.
引文
[1]中国卒中学会,卒中后认知障碍管理专家委员会.卒中后认知障碍管理专家共识[J].中国卒中杂志, 2017,12:519-531
[2]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48:246-257
[3] Naess H, Kurtz M, Thomassen L, et al. Serial NIHSS scores in patients with acute cerebral infarction[J]. Acta Neurol Scand,2016, 133:415-420
[4]高小玲,石艳,张明昊,等. MMSE与MoCA在维持性血液透析患者认知损害诊断中灵敏性的比较分析[J].中国血液净化, 2016. 15:451-454
[5] Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment[J]. Stroke, 1993, 24:35-41
[6] Hachinski V, World Stroke Organization. Stroke and Potentially Preventable Dementias Proclamation:Updated World Stroke Day Proclamation[J]. Stroke, 2015, 46:3039-3940
[7] Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2016, 47:e98-e169
[8] Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment:epidemiology, mechanisms and management[J]. Ann Transl Med,2014, 2:80
[9] Jacquin A, Binquet C, Rouaud O, et al. Post-stroke cognitive impairment:high prevalence and determining factors in a cohort of mild stroke[J]. J Alzheimers Dis, 2014, 40:1029-1038
[10]Tu Q, Ding B, Yang X, et al. The current situation on vascular cognitive impairment after ischemic stroke in Changsha[J]. Arch Gerontol Geriatr, 2014, 58:236-247
[11]Wollenweber FA, Zietemann V, Rominger A, et al. The Determinants of Dementia After Stroke(DEDEMAS)Study:protocol and pilot data[J]. Int J Stroke, 2014, 9:387-392
[12]Zhai LP, Zhang XL, Guan QB, et al. Influence of glucose metabolism on cognitive function of patients with acute smallartery occlusion[J]. J Biol Regul Homeost Agents, 2017, 31:717-724
[13]Washida K, Ihara M, Tachibana H, et al. Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke[J]. J Stroke Cerebrovasc Dis, 2014, 23:2250-2255
[14]Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke:predictorsand dynamics of significant determinants[J]. Turk J Med Sci, 2016, 46:1366-1373
[15]Chibber S, Alexiou A, Alama MN, et al. A synopsis on the linkage between age-related dementias and vascular disorders[J]. CNS Neurol Disord Drug Targets, 2016, 15:250-258
[16]Akinyemi RO, Allan LM, Oakley A, et al. Hippocampal Neurodegenerative Pathology in Post-stroke Dementia Compared to Other Dementias and Aging Controls[J]. Front Neurosci,2017, 11:717
[17]Ward R, Valenzuela JP, Li WG, et al. Post Stroke Cognitive Impairment and Hippocampal Neurovascular Remodeling:The Impact of Diabetes and Sex[J]. Am J Physiol Heart Circ Physiol, 2018
[18]Fann DY, Santro T, Manzanero S, et al. Intermittent fasting attenuates inflammasome activity in ischemic stroke[J]. Exp Neurol, 2014, 257:114-119
[19]Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke,and vascular risk factors; a review[J]. Int J Stroke, 2012, 7:61-73
[20]Mansur RB, Cha DS, Woldeyohannes HO, et al. Diabetes mellitus and disturbances in brain connectivity:a bidirectional relationship[J]. Neuromolecular Med, 2014, 16:658-668
[21]Khedr EM, Hamed SA, El-Shereef HK, et al. Cognitive impairment after cerebrovascular stroke:Relationship to vascular risk factors[J]. Neuropsychiatr Dis Treat, 2009, 5:103-116
[22]Rothenburg LS, Herrmann N, Swardfager W, et al. The relationship between inflammatory markers and post stroke cognitive impairment[J]. J Geriatr Psychiatry Neurol, 2010,23:199-205
[23]刘增玲,李文,李海龙,等.血管性认知功能障碍非痴呆型患者外周血炎性标记物的临床研究[J].中国临床神经科学,2013, 21:32-36
[24]Zhou Y, Han W, Gong D, et al. Hs-CRP in stroke:A metaanalysis[J]. Clin Chim Acta, 2016, 453:21-27
[25]Matsuo R, Ago T, Hata J, et al. Plasma C-Reactive Protein and Clinical Outcomes after Acute Ischemic Stroke:A Prospective Observational Study[J]. PLo S One, 2016, 11:e0156790
[26]Guo J, Su W, Fang J, et al. Elevated CRP at admission predicts post-stroke cognitive impairment in Han Chinese patients with intracranial arterial stenosis[J]. Neurol Res, 2018, 40:292-296
[27]da Costa FA, da Silva DL, da Rocha VM.[The neurological state and cognition of patients after a stoke][J]. Rev Esc Enferm USP, 2011, 45:1083-1088
[28]Chen X, Duan L, Han Y, et al. Predictors for vascular cognitive impairment in stroke patients[J]. BMC Neurol, 2016, 16:115
[29]Takada M.[Neuroanatomy of Frontal Association Cortex][J].Brain Nerve, 2016, 68:1253-1261
[30]Morel M, Héraud C, Nicaise C, et al. Levels of kinesin light chain and dynein intermediate chain are reduced in the frontal cortex in Alzheimer's disease:implications for axoplasmic transport[J]. Acta Neuropathol, 2012, 123:71-84
[31]Mayes AR, Montaldi D, Roper A, et al. Amount, not strength of recollection, drives hippocampal activity:A problem for apparent word familiarity-related hippocampal activation[J].Hippocampus, 2019,29:46-59
[32]Maeshima S, Osawa A, Yamane F, et al. Retrosplenial amnesia without topographic disorientation caused by a lesion in the nondominant hemisphere[J]. J Stroke Cerebrovasc Dis, 2014,23:441-445
[33]Tokoro K, Sato H, Yamamoto M, et al.[Thalamus and Attention][J]. Brain Nerve, 2015, 67:1471-1480
[34]Kulesh AA, Drobakha VE, Nekrasova IV, et al.[Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke][J]. Vestn Ross Akad Med Nauk, 2016, 71:304-312
[35]Baumgartner P, El Amki M, Bracko O, et al. Sensorimotor stroke alters hippocampo-thalamic network activity[J]. Sci Rep,2018, 8:15770
[36]Li S, Sun X, Bai YM, et al. Infarction of the corpus callosum:a retrospective clinical investigation[J]. PLo S One, 2015, 10:e0120409
[37]Frederiksen KS. Corpus callosum in aging and dementia[J].Dan Med J, 2013, 60:B4721
[38]Wolf G, Lotan A, Lifschytz T, et al. Differentially Severe Cognitive Effects of Compromised Cerebral Blood Flow in Aged Mice:Association with Myelin Degradation and Microglia Activation[J]. Front Aging Neurosci, 2017, 9:191
[39]Weiss N, Miller F, Cazaubon S, et al. The blood-brain barrier in brain homeostasis and neurological diseases[J]. Biochim Biophys Acta, 2009, 1788:842-857
[40]Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia:an update[J]. Nat Rev Neurol, 2015,11:157-165
[41]Kloppenborg RP, Nederkoorn PJ, Geerlings MI, et al. Presence and progression of white matter hyperintensities and cognition:a meta-analysis[J]. Neurology, 2014, 82:2127-2138
[42]Mandzia JL, Smith EE, Horton M, et al. Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days[J]. Stroke,2016,47:726-731
[2]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48:246-257
[3] Naess H, Kurtz M, Thomassen L, et al. Serial NIHSS scores in patients with acute cerebral infarction[J]. Acta Neurol Scand,2016, 133:415-420
[4]高小玲,石艳,张明昊,等. MMSE与MoCA在维持性血液透析患者认知损害诊断中灵敏性的比较分析[J].中国血液净化, 2016. 15:451-454
[5] Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment[J]. Stroke, 1993, 24:35-41
[6] Hachinski V, World Stroke Organization. Stroke and Potentially Preventable Dementias Proclamation:Updated World Stroke Day Proclamation[J]. Stroke, 2015, 46:3039-3940
[7] Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2016, 47:e98-e169
[8] Sun JH, Tan L, Yu JT. Post-stroke cognitive impairment:epidemiology, mechanisms and management[J]. Ann Transl Med,2014, 2:80
[9] Jacquin A, Binquet C, Rouaud O, et al. Post-stroke cognitive impairment:high prevalence and determining factors in a cohort of mild stroke[J]. J Alzheimers Dis, 2014, 40:1029-1038
[10]Tu Q, Ding B, Yang X, et al. The current situation on vascular cognitive impairment after ischemic stroke in Changsha[J]. Arch Gerontol Geriatr, 2014, 58:236-247
[11]Wollenweber FA, Zietemann V, Rominger A, et al. The Determinants of Dementia After Stroke(DEDEMAS)Study:protocol and pilot data[J]. Int J Stroke, 2014, 9:387-392
[12]Zhai LP, Zhang XL, Guan QB, et al. Influence of glucose metabolism on cognitive function of patients with acute smallartery occlusion[J]. J Biol Regul Homeost Agents, 2017, 31:717-724
[13]Washida K, Ihara M, Tachibana H, et al. Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke[J]. J Stroke Cerebrovasc Dis, 2014, 23:2250-2255
[14]Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke:predictorsand dynamics of significant determinants[J]. Turk J Med Sci, 2016, 46:1366-1373
[15]Chibber S, Alexiou A, Alama MN, et al. A synopsis on the linkage between age-related dementias and vascular disorders[J]. CNS Neurol Disord Drug Targets, 2016, 15:250-258
[16]Akinyemi RO, Allan LM, Oakley A, et al. Hippocampal Neurodegenerative Pathology in Post-stroke Dementia Compared to Other Dementias and Aging Controls[J]. Front Neurosci,2017, 11:717
[17]Ward R, Valenzuela JP, Li WG, et al. Post Stroke Cognitive Impairment and Hippocampal Neurovascular Remodeling:The Impact of Diabetes and Sex[J]. Am J Physiol Heart Circ Physiol, 2018
[18]Fann DY, Santro T, Manzanero S, et al. Intermittent fasting attenuates inflammasome activity in ischemic stroke[J]. Exp Neurol, 2014, 257:114-119
[19]Sahathevan R, Brodtmann A, Donnan GA. Dementia, stroke,and vascular risk factors; a review[J]. Int J Stroke, 2012, 7:61-73
[20]Mansur RB, Cha DS, Woldeyohannes HO, et al. Diabetes mellitus and disturbances in brain connectivity:a bidirectional relationship[J]. Neuromolecular Med, 2014, 16:658-668
[21]Khedr EM, Hamed SA, El-Shereef HK, et al. Cognitive impairment after cerebrovascular stroke:Relationship to vascular risk factors[J]. Neuropsychiatr Dis Treat, 2009, 5:103-116
[22]Rothenburg LS, Herrmann N, Swardfager W, et al. The relationship between inflammatory markers and post stroke cognitive impairment[J]. J Geriatr Psychiatry Neurol, 2010,23:199-205
[23]刘增玲,李文,李海龙,等.血管性认知功能障碍非痴呆型患者外周血炎性标记物的临床研究[J].中国临床神经科学,2013, 21:32-36
[24]Zhou Y, Han W, Gong D, et al. Hs-CRP in stroke:A metaanalysis[J]. Clin Chim Acta, 2016, 453:21-27
[25]Matsuo R, Ago T, Hata J, et al. Plasma C-Reactive Protein and Clinical Outcomes after Acute Ischemic Stroke:A Prospective Observational Study[J]. PLo S One, 2016, 11:e0156790
[26]Guo J, Su W, Fang J, et al. Elevated CRP at admission predicts post-stroke cognitive impairment in Han Chinese patients with intracranial arterial stenosis[J]. Neurol Res, 2018, 40:292-296
[27]da Costa FA, da Silva DL, da Rocha VM.[The neurological state and cognition of patients after a stoke][J]. Rev Esc Enferm USP, 2011, 45:1083-1088
[28]Chen X, Duan L, Han Y, et al. Predictors for vascular cognitive impairment in stroke patients[J]. BMC Neurol, 2016, 16:115
[29]Takada M.[Neuroanatomy of Frontal Association Cortex][J].Brain Nerve, 2016, 68:1253-1261
[30]Morel M, Héraud C, Nicaise C, et al. Levels of kinesin light chain and dynein intermediate chain are reduced in the frontal cortex in Alzheimer's disease:implications for axoplasmic transport[J]. Acta Neuropathol, 2012, 123:71-84
[31]Mayes AR, Montaldi D, Roper A, et al. Amount, not strength of recollection, drives hippocampal activity:A problem for apparent word familiarity-related hippocampal activation[J].Hippocampus, 2019,29:46-59
[32]Maeshima S, Osawa A, Yamane F, et al. Retrosplenial amnesia without topographic disorientation caused by a lesion in the nondominant hemisphere[J]. J Stroke Cerebrovasc Dis, 2014,23:441-445
[33]Tokoro K, Sato H, Yamamoto M, et al.[Thalamus and Attention][J]. Brain Nerve, 2015, 67:1471-1480
[34]Kulesh AA, Drobakha VE, Nekrasova IV, et al.[Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke][J]. Vestn Ross Akad Med Nauk, 2016, 71:304-312
[35]Baumgartner P, El Amki M, Bracko O, et al. Sensorimotor stroke alters hippocampo-thalamic network activity[J]. Sci Rep,2018, 8:15770
[36]Li S, Sun X, Bai YM, et al. Infarction of the corpus callosum:a retrospective clinical investigation[J]. PLo S One, 2015, 10:e0120409
[37]Frederiksen KS. Corpus callosum in aging and dementia[J].Dan Med J, 2013, 60:B4721
[38]Wolf G, Lotan A, Lifschytz T, et al. Differentially Severe Cognitive Effects of Compromised Cerebral Blood Flow in Aged Mice:Association with Myelin Degradation and Microglia Activation[J]. Front Aging Neurosci, 2017, 9:191
[39]Weiss N, Miller F, Cazaubon S, et al. The blood-brain barrier in brain homeostasis and neurological diseases[J]. Biochim Biophys Acta, 2009, 1788:842-857
[40]Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia:an update[J]. Nat Rev Neurol, 2015,11:157-165
[41]Kloppenborg RP, Nederkoorn PJ, Geerlings MI, et al. Presence and progression of white matter hyperintensities and cognition:a meta-analysis[J]. Neurology, 2014, 82:2127-2138
[42]Mandzia JL, Smith EE, Horton M, et al. Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days[J]. Stroke,2016,47:726-731