缺血性卒中患者急性期认知障碍研究

摘要/Abstract

摘要：

目的探讨缺血性卒中患者急性期认知障碍的特点。方法本研究为前瞻性研究，连续选取2011年3月～2012年6月广州市第一人民医院神经内科住院的急性缺血性卒中患者220例为病例组，同时在社区、体检中心、患者家属中收集健康对照者146例为对照组，采用蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）、简易精神状态检查量表（Mini-Mental State Examination，MMSE）对研究对象进行测评，依据MMSE和MoCA总分将病例组分为4 个亚组，A组（MMSE＜26分，MoCA≤23分）93例，B组（MMSE得分在26～27分，MoCA≤23分）36例，C组（MMSE≥28分，MoCA≤23分）24例，D组（MMSE、MoCA得分均正常）67例，评估各亚分组认知功能下降的情况。结果缺血性卒中急性期患者的MMSE总分（25.07±3.99），MoCA总分（17.70±5.77）均较正常对照组的MMSE总分（27.73±1.89）和MoCA总分（23.96±3.44）下降（P＜0.05）。病例组和对照组MoCA各亚项比较，命名项目比较差异无显著性［病例组3（2，3），对照组3（2，3），P =0.159］。MoCA各亚项目病例组的A组｛视空间和执行功能［1（0，2）］、命名［2（1，3）］，记忆［1（0，2）］、注意力［3（2，5）］、语言［0（0，0）］、抽象［0（0，1）］、定向力［4（3，5）］｝、B亚组｛视空间和执行功能［1（1，2）］、命名［2（1，3）］，记忆［2（0，3）］、注意力［5（4，6）］、语言［0（0，0）］、抽象［1（1，2）］、定向力［6（5， 6）］｝均较对照组｛视空间和执行功能［4（3，5）］、命名［3（2，3）］，记忆［3（2，4）］、注意力［6（5， 6）］、语言［2（1，2）］、抽象［2（1，2）］、定向力［6（6，6）］｝下降（P＜0.05），C组患者在视空间和执行功能［2（1，3.75）］、语言［0（0，0）］、记忆［2（1，3）］3个分项得分与对照组｛视空间和执行功能［4（3，5）］，语言［2（1，2）］，记忆［3（2，4）］｝比较差异均具有显著性（P＜0.05）。结论急性期缺血性卒中患者存在认知受损的表现，其认知受损可累及多个认知域，而在MMSE不能识别的轻度认知障碍患者中则以视空间和执行功能异常、语言障碍和记忆下降为主要临床表现。

文章导读： ESRS评分对TIA、缺血性小卒中和缺血性大卒中患者进行卒中复发均有一定的预测作用，但不十分
理想，应该建立更适中国人群的卒中复发预测模型。

关键词: 卒中; 血管性认知障碍; 临床特征

Abstract:

Objective To explore the features of cognitive impairment among patients with acute ischemic stroke. Methods In this prospective study, data were collected consecutively from 220 in-patients at the Neurology Department of Guangzhou First People's Hospital from March 2011 to June 2012. These patients were assessed with both Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) at the day of enrollment. Simultaneously, a control group of 146 healthy individuals from matched background was also set up. Control subjects were enrolled from community centers, physical examination center in our hospital and some of them were relatives of the patients as well. The patients were classified into subgroups based on the total scores of MoCA and MMSE, respectively. There are four subgroup: Group A (MMSE<26, MoCA 23) with 93 patients, Group B (the scores of MMSE are between 26~27, MoCA 23) with 36 patients, Group C (MMSE 28, MOCA 23) with 24 patients, Group D (those with normal scores in both MMSE and MOCA) with 67 patients. Results Patients scored less than the controls overall on both the MMSE (25.07±3.99 vs 27.73±1.89) and MoCA (17.70±5.77 vs 23.96±3.44), (P <0.05). There is no statistic difference in the naming subtests of MoCA in the two groups (patient group 3[2, 3], control group 3[2, 3], P =0.159). A comparison of the subtest scores of MoCA suggests that the subgroup A (visuospatial/ executive function [1{0, 2}], naming [2{1, 3}], recall [1{0, 2}], attention [3{2, 5}], language [0{0, 0}], abstraction [0{0, 1}], orientation [4{3, 5}]) and subgroup B (visuospatial/executive function [1{1, 2}], naming [2{1, 3}], recall [2{0, 3}], attention [5{4, 6}], language [0{0, 0}], abstraction [1{1, 2}], orientation [6{5, 6}]) have worse performances than the control group (visuospatial/ executive function [4{3, 5}], naming [3{2, 3}], recall [3{2, 4}], attention [6{5, 6}], language [2{1, 2}], abstraction [2{1, 2}], orientation [6{6, 6}]) (P <0.05), while subgroup C show decreased score in visuospatial/executive function (2[1, 3.75]), language (0[0, 0]) and recall (2[1, 3]) (P <0.05). Conclusion Patients with acute ischemic stroke suffered from cognitive impairment in all subdomains of MoCA except naming. Visuospatial/executive function, language and recall impairment are the main clinical features in patients with mild cognitive impairment who cannot be recognized by MMSE.

Key words: Stroke; Vascular cognitive impairment; Clinical features

陈浩博，潘小平，胡蓉，胡键浠，吴玉，莫小恩. 缺血性卒中患者急性期认知障碍研究[J]. 中国卒中杂志, 2014, 9(06): 493-498.

CHEN Hao-Bo, PAN Xiao-Pin, HU Rong, HU Jian-Xi, WU Yu, MO Xiao-En.. A Study of the Clinical Features of Cognitive Impairment among Patients with Acute
Ischemic Stroke[J]. Chinese Journal of Stroke, 2014, 9(06): 493-498.

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