论文部分内容阅读
目的 探讨缺血性脑卒中急性期简短认知功能评估对卒中后3～6个月认知功能的预测作用.方法 前瞻性登记2016年8月至2017年12月连续住院的254例急性缺血性脑卒中患者的人口学资料、血管性危险因素、临床及影像学资料.卒中发病后3周采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行简易认知评估.卒中3～6个月后对患者进行成套认知功能评估,采用多因素Logistic回归分析3～6个月各认知域及总体认知功能的独立危险因素.结果 连续入组急性缺血性脑卒中患者254例.结合入组和排除标准,最终161例患者完成基线简短认知评估,其中138例在卒中3～6个月完成成套认知测评.多因素Logistic回归分析显示,3周基线认知状态是卒中后3～6月记忆(P＜0.05,OR=62.47,95％CI=13.00～205.00)、执行(P＜0.05,OR=38.29,95％CI=8.00～ 170.00)、语言(P＜0.05,OR=6.46,95％CI=2.31～ 18.04)及信息处理速度(P＜0.05,OR=5.88,95％CI=2.24～ 15.41)认知域的独立影响因素.按照受损认知域多少定义总体认知功能状态,无/轻度认知功能异常组61例,中/重度认知功能障碍组77例.多因素Logistic分析显示,调整年龄和受教育水平等因素后,基线认知状态与卒中后3～6月总体认知功能独立相关(P＜0.05,OR=25.32,95％CI=7.52～85.39).结论 卒中后早期简短认知功能评估可以预测卒中后稳定期记忆、执行、语言及信息处理速度认知域的功能状态,也可以预测总体认知水平.“,”Objective To explore the predictive value of short term cognitive assessment in the acute phase of ischemic stroke for 3-6 months after stroke.Methods The demographic data,vascular risk factors,clinical and imaging data of 254 patients with acute ischemic stroke from August 2016 to December 2017 were prospectively registered.The cognitive function was assessed by Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) 3 weeks after stroke onset.Comprehensive cognitive function assessment was performed after 3-6 months of stroke.Multiple factor Logistic regression was used to screen the independent risk factors of cognitive domain and overall cognitive function in 3-6 months.Results Totally 254 consecutive patients with acute ischemic stroke were enrolled.Combined with the inclusion and exclusion criteria,161 patients completed the baseline cognitive assessment,and 138 completed the comprehensive cognitive assessment in 3-6 months after stroke.Logistic regression analysis showed that 3 weeks baseline cognitive status was an independent factor affecting memory (P＜0.05,OR =62.47,95％CI=13.00-205.00),execution (P＜0.05,OR=38.29,95％CI=8.00-170.00),language (P＜0.05,OR=6.46,95％CI=2.31-18.04) and information processing speed (P＜0.05,OR=5.88,95％CI=2.24-15.41) in 3-6 months after stroke.According to the number of impaired cognitive domains,the overall cognitive function was defined.There were 61 cases of no or mild cognitive dysfunction group and 77 cases of moderate or severe cognitive impairment group.Multifactor logistic analysis showed that baseline cognitive status was independent of the overall cognitive function of 3-6 months after apoplexy adjusting for the age and education level (P＜0.05,OR=25.32,95％ CI =7.52-85.39).Conclusion Short cognitive assessment in early apoplexy can predict the short-term functional status of cognitive domains such as memory,execution,language and information processing speed after stroke,and can also predict the overall cognitive level.