老年脑梗死患者认知功能下降的特点及危险因素分析

发布时间：2018-05-24 05:43

本文选题：脑梗死 + 老年人　；参考：《中国脑血管病杂志》2017年05期

【摘要】：目的探讨老年脑梗死患者认知功能下降的特点及其影响因素。方法采取横断面研究,在2014年11月13日至2014年12月21日对江苏省如皋市江安镇人群进行调查。样本来自“如皋衰老纵向研究”,纳入31个村的1 788名对象,年龄70~84岁,均为汉族,其中男830名,女958名。确认脑梗死病史根据二级以上医院神经科诊断或头部CT证实。认知功能的评价采用改良长谷川痴呆量表,对该人群的定向力、记忆力、近记忆力、计算力及常识5个维度进行评价,总分21.5为无认知功能障碍,≤21.5为有认知功能障碍。采用多因素Logistic回归分析老年脑梗死患者认知功能下降的危险因素。结果 (1)1 788名受检者中,合并脑梗死病史133例(7.4%),无脑梗死1 655名。合并脑梗死患者高血压的比例高于无脑梗死组[63.9%(85例)比41.7%(690例)],高密度脂蛋白胆固醇水平低于无脑梗死组[(1.40±0.29)mmol/L比(1.47±0.33)mmol/L],差异均有统计学意义(均P0.05)。(2)合并脑梗死患者在定向力和计算力方面存在部分受损,总体认知功能评分为(20±7)分,较无脑梗死患者的(21±6)明显下降,两组比较差异有统计学意义(P0.05)。(3)133例脑梗死患者中,存在认知功能障碍的76例,发生率为57.1%,其中女性59例。认知功能障碍患者血肌酐平均值为(59±15)μmol/L,较无认知障碍者(66±14)μmol/L明显降低,差异有统计学意义(P0.05)。(4)多因素Logistic回归分析显示,小学以下教育程度(OR=2.86,95%CI:2.19~3.72)、女性(OR=1.85,95%CI:1.50~2.28),是老年脑梗死患者认知功能下降的独立危险因素,较高血肌酐浓度(OR=0.96,95%CI:0.95~0.97)是保护因素。结论脑梗死后的老年人总体认知功能下降,尤其是定向力和计算力方面受损明显。小学以下文化程度和女性是发生认知障碍的独立危险因素,较高水平血肌酐可能具有一定的保护作用。
[Abstract]:Objective to investigate the characteristics and influencing factors of cognitive decline in elderly patients with cerebral infarction. Methods a cross-sectional study was carried out in Jiang'an Town, Rugao, Jiangsu Province, from November 13, 2014 to December 21, 2014. The sample came from "Rugao senescence longitudinal study", which included 1788 subjects in 31 villages, aged 70~84 years old. Among them, there were 830 men and 958 women. The history of cerebral infarction was confirmed according to the diagnosis of neurology or CT in the hospital over level two. The evaluation of cognitive function was evaluated by the modified Kyohko Hasegawa dementia scale, and the orientation, memory, memory, computational power and common sense of the population were evaluated in 5 dimensions. The total score was 21.5 with no cognitive impairment and less than 21.5. The risk factors of cognitive impairment were analyzed by multiple factor Logistic regression. Results (1) among the 1788 subjects, 133 cases (7.4%) had a history of cerebral infarction (7.4%), and 1655 had no cerebral infarction. The proportion of hypertension in the patients with cerebral infarction was higher than that in the non cerebral infarction group (85 cases) and 41.7% (690 cases)), and the high density was higher than that of the patients with cerebral infarction (690 cases). The level of lipoprotein cholesterol was lower than that of the non cerebral infarction group [(1.40 + 0.29) mmol/L ratio (1.47 + 0.33) mmol/L]), and the difference was statistically significant (P0.05). (2) the patients with cerebral infarction were partially damaged in directional and computational power, and the overall cognitive function score was (20 + 7), compared with those without cerebral infarction (21 + 6), and two groups were different. Statistical significance (P0.05). (3) of the 133 patients with cerebral infarction, there were 76 cases of cognitive dysfunction, the incidence of which was 57.1%, of which 59 cases were in women. The mean value of creatinine in cognitive dysfunction patients was (59 + 15) mu mol/L, compared with those without cognitive impairment (66 + 14) mu mol/L, the difference was statistically significant (P0.05). (4) multiple factor Logistic regression analysis The education level below primary school (OR=2.86,95%CI:2.19~3.72) and female (OR=1.85,95%CI:1.50~2.28) were independent risk factors for cognitive decline in elderly patients with cerebral infarction, and higher serum creatinine concentration (OR=0.96,95%CI:0.95~0.97) was a protective factor. Conclusion the overall cognitive function of the elderly after cerebral infarction was decreased, especially the orientation and calculation. The level of culture and women are independent risk factors for cognitive impairment, and high level of blood creatinine may have a certain protective effect.
【作者单位】：首都医科大学附属北京朝阳医院神经内科;同济大学医学院病理学与病理生理学系;复旦大学生命科学学院;如皋市人民医院神经内科;
【分类号】：R743.3

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