缺血性脑卒中急性期认知障碍症状学分型研究
发布时间：2019-06-07 08:07
【摘要】：目的:通过对缺血性脑卒中急性期患者进行全面神经心理学评估,对其进行以症状学为基础的新型分型,并探讨不同分型之间流行病学、影像学及神经功能损害程度的差异。以便更好地识别血管性认知障碍,并及时给予相应的临床干预,改善预后。方法:连续收集2013年11月-2014年11月浙江大学附属第一医院神经内科和嘉兴市第二医院神经内科收治的符合纳入和排除标准的急性缺血性脑卒中患者208例,依次记录患者的年龄、性别、受教育年限、既往史、入院时的美国国立卫生院卒中量表评分和改良Rankin量表分级、实验室检查以及影像学情况,并采用简易精神状态量表、阿尔兹海默病评定量表认知分量表、临床痴呆量表等量表评估患者认知功能,根据美国国立疾病与卒中研究所和瑞士神经科学研究国际协会和美国心脏协会/美国卒中协会有关血管性痴呆和血管性轻度认知障碍诊断标准,将血管性痴呆及血管性轻度认知障碍临床结果分为"1.很可能,2.可能,3.肯定,4.否",将同时满足血管性痴呆及血管性轻度认知障碍为"否"的患者纳入认知功能正常组,将患者分为认知功能正常组及血管性认知障碍组,其中血管性认知障碍组按阿尔兹海默病评定量表认知分量表评分中语言、操作、记忆三个领域评分的中位数为标准进行症状学分型,可分成记忆损伤为主型、语言损伤为主型、操作损伤为主型、混合型。采用SPSS22.0统计软件进行统计学分析,比较各亚型之间的基线特征、影像学特征及入院时神经功能缺损情况。结果:缺血性卒中急性期患者按认知障碍症状学特点分为五型:正常型61例(29.33%);记忆损伤为主型10例(4.81%);语言损伤为主型35例(16.83%),操作损伤为主型14例(6.73%);混合型88例(42.31%)。各型在年龄、受教育年限、性别间差异具有统计学意义(P0.05),而在糖尿病、高血压病、高脂血症及卒中史间差异不具有统计意义(P0.05);各型在梗死部位和梗死数量上差异无统计学意义(P0.05);各型在入院时改良Rankin量表分级和美国国立卫生院卒中量表评分比较(P=0.298,P=0.403),差异均无统计学意义(P0.05)。结论:缺血性卒中急性期患者大多存在认知障碍,本研究发现血管性认知障碍按症状学可分为五型,该分型反映血管性认知障碍的异质性:认知功能损害的不同领域随年龄变化有各自的特点,年龄越大,其对记忆、注意和视空间能力的损伤越大,对语言的影响则相对较小。而受教育水平可能更多地影响语言的抽象和概括能力,与注意、记忆功能的关系不大。男性在操作上优于女性,但在记忆和语言上更容易受损害;各亚型间影像学征象和神经功能缺损等并无明显差异,需要进一步研究各症状缺损机制以帮助针对性神经康复。
[Abstract]:Objective: to evaluate the patients with acute ischemic stroke by comprehensive neuropsychological evaluation, and to explore the difference of epidemiological, imaging and neurological impairment among different types. In order to better identify vascular cognitive impairment and give corresponding clinical intervention in time to improve prognosis. Methods: 208 patients with acute ischemic stroke who met the inclusion and exclusion criteria were collected from November 2013 to November 2014 in the Department of Neurology, the first affiliated Hospital of Zhejiang University and the Department of Neurology, Jiaxing second Hospital. The patient's age, sex, years of education, past history, National Hospital Stroke scale score and modified Rankin scale rating, laboratory examination and imaging status were recorded in turn, and a simple mental state scale was used. Alzheimer's disease rating scale cognitive subscale, clinical dementia scale and other scales to evaluate the cognitive function of patients, According to the National Institute of Disease and Stroke and the Swiss International Association for Neuroscientific Research and the American Heart Association / American Stroke Association for the diagnosis of vascular dementia and vascular mild cognitive impairment, The clinical results of vascular dementia and vascular mild cognitive impairment were divided into "1. It is likely that, 2. Maybe, 3. Sure, 4. No, the patients who met both vascular dementia and vascular mild cognitive impairment were included in the normal cognitive function group, and the patients were divided into normal cognitive function group and vascular cognitive impairment group. Among them, the vascular cognitive impairment group was divided into memory impairment type and language injury type according to the median score of language, operation and memory in the cognitive subscale of Alzheimer's disease rating scale. Operation damage is the main type, mixed type. SPSS22.0 statistical software was used for statistical analysis, and the baseline features, imaging features and neurological deficit at admission were compared. Results: according to the symptomatic characteristics of cognitive impairment, the patients with acute ischemic stroke were divided into five types: normal type in 61 cases (29.33%), memory impairment in 10 cases (4.81%), and memory impairment in 10 cases (4.81%). Language injury was the main type in 35 cases (16.83%), operation injury in 14 cases (6.73%) and mixed type in 88 cases (42.31%). There were significant differences in age, years of education and gender (P 0.05), but there was no significant difference in diabetes, hypertension, hyperlipidemia and stroke history (P 0.05). There was no significant difference in the location and number of infarction among each type (P 0.05). There was no significant difference between the improved Rankin scale on admission and the National Hospital Stroke scale score (P 鈮，
本文编号：2494646
[Abstract]:Objective: to evaluate the patients with acute ischemic stroke by comprehensive neuropsychological evaluation, and to explore the difference of epidemiological, imaging and neurological impairment among different types. In order to better identify vascular cognitive impairment and give corresponding clinical intervention in time to improve prognosis. Methods: 208 patients with acute ischemic stroke who met the inclusion and exclusion criteria were collected from November 2013 to November 2014 in the Department of Neurology, the first affiliated Hospital of Zhejiang University and the Department of Neurology, Jiaxing second Hospital. The patient's age, sex, years of education, past history, National Hospital Stroke scale score and modified Rankin scale rating, laboratory examination and imaging status were recorded in turn, and a simple mental state scale was used. Alzheimer's disease rating scale cognitive subscale, clinical dementia scale and other scales to evaluate the cognitive function of patients, According to the National Institute of Disease and Stroke and the Swiss International Association for Neuroscientific Research and the American Heart Association / American Stroke Association for the diagnosis of vascular dementia and vascular mild cognitive impairment, The clinical results of vascular dementia and vascular mild cognitive impairment were divided into "1. It is likely that, 2. Maybe, 3. Sure, 4. No, the patients who met both vascular dementia and vascular mild cognitive impairment were included in the normal cognitive function group, and the patients were divided into normal cognitive function group and vascular cognitive impairment group. Among them, the vascular cognitive impairment group was divided into memory impairment type and language injury type according to the median score of language, operation and memory in the cognitive subscale of Alzheimer's disease rating scale. Operation damage is the main type, mixed type. SPSS22.0 statistical software was used for statistical analysis, and the baseline features, imaging features and neurological deficit at admission were compared. Results: according to the symptomatic characteristics of cognitive impairment, the patients with acute ischemic stroke were divided into five types: normal type in 61 cases (29.33%), memory impairment in 10 cases (4.81%), and memory impairment in 10 cases (4.81%). Language injury was the main type in 35 cases (16.83%), operation injury in 14 cases (6.73%) and mixed type in 88 cases (42.31%). There were significant differences in age, years of education and gender (P 0.05), but there was no significant difference in diabetes, hypertension, hyperlipidemia and stroke history (P 0.05). There was no significant difference in the location and number of infarction among each type (P 0.05). There was no significant difference between the improved Rankin scale on admission and the National Hospital Stroke scale score (P 鈮，
本文编号：2494646
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