Analysis of Influencing Factors of Cognitive Impairment in Patients with Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2017.09.012

Abstract

Abstract:

Objective To evaluate the influencing factors of cognitive impairment after acute ischemic stroke. Methods The study included 3285 patients who were subjects from the Study on Oxidative Stress in Patients with Acute Ischemic Stroke. The cognitive function of patients were determined by minimental state examination (MMSE), and the influence factors of cognitive impairment in patients with acute ischemic stroke were evaluated in multiple logistic regression analysis. Results The prevalence of cognitive impairment after acute ischemic stroke was 26.46% (n =869), and the difference between the groups in the aspect of patient's age, sex, place of residence, education, exercise, and National Institutes of Health Stroke Scale (NIHSS) score were statistically significant. Logistic regression analysis showed that the risk factors of cognitive impairment after acute ischemic stroke were hyperlipidemia [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.01-1.89, P =0.043), women (OR 1.30, 95%CI 1.04-1.63, P =0.020), high National Institutes of Health Stroke Scale (NIHSS) score (OR 1.26, 95%CI 1.24-1.30, P <0.001), living in rural areas (OR 1.25, 95%CI 1.02- 1.53, P =0.026) and advanced age (OR 1.03, 95%CI 1.02-1.04, P <0.001). High education level (OR 0.77, 95%CI 0.63-0.92, P =0.015) and frequent exercise (OR 0.80, 95%CI 0.66-0.97, P =0.020) were

protective factors. Conclusion We should comprehensively take into account the influencing factors of cognitive impairment in patients with acute ischemic stroke.

Key words: Acute ischemic stroke; Cognitive impairment; Influencing factors

摘要：

目的探讨急性缺血性卒中患者认知功能障碍的影响因素。方法选取急性缺血性卒中患者氧化应激水平临床观察研究（Study on Oxidative Stress in Patients with Acute Ischemic Stroke，SOS-Stroke）的3285例患者作为研究对象，采用简易智力状态检查量表（mini-mental state examination，MMSE）测定患者认知功能，急性缺血性卒中患者认知功能障碍的影响因素采用多因素Logistic回归进行分析。结果该研究人群中有869例（26.45%）患有认知功能障碍，患者的年龄、性别、居住地、教育程度、运动情况、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分对急性缺血性卒中后认知功能障碍的影响有统计学意义。高脂血症[比值比（odds ratio，OR）1.38，95% 可信区间（confidence interval，CI）1.01～1.89，P =0.043] 、女性（OR 1.30，95%CI 1.04～1.63，P =0.020）、 NIHSS评分高（OR 1.26，95%CI 1.24～1.30，P <0.001）、居住于农村（OR 1.25，95%CI 1.02～1.53， P =0.026）及高龄（OR 1.03，95%CI 1.02～1.04，P <0.001）是急性缺血性卒中患者认知功能障碍的危险因素，高教育水平（OR 0.77，95%CI 0.63～0.92，P =0.015）和经常运动（OR 0.80，95%CI 0.66～0.97， P =0.020）是其保护因素。结论应综合考虑急性缺血性卒中患者认知功能障碍的影响因素。

关键词: 急性缺血性卒中; 认知功能障碍; 影响因素

CHEN Yong-Ming, LV Wei, ZHANG Jian-Ming, JIA Xiao-Lin, MENG Xia. Analysis of Influencing Factors of Cognitive Impairment in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2017, 12(09): 822-826.

陈永明，吕薇，张建明，贾晓琳，孟霞. 急性缺血性卒中患者认知功能障碍影响因素分析[J]. 中国卒中杂志, 2017, 12(09): 822-826.

References

[1] BRODTMANN A，WERDEN E，PARDOE H，et al.

Charting cognitive and volumetric trajectories after

stroke：protocol for the cognition and neocortical

volume after stroke（CANVAS）study[J]. Int J Stroke，

2014，9（6）：824-828.

[2] 贾建平，魏翠柏. 血管性认知损害——预防重于治疗

[J]. 中国现代神经疾病杂志，2010，10（3）：277-278.

[3] WANG A，LIU X，CHEN G，et al. Association

between carotid plaque and cognitive impairment in

chinese stroke population：the SOS-stroke study[J].

Scientific Reports，2017，7（1）：3066.

[4] WANG A，WU J，ZHOU Y，et al. Measures of

adiposity and risk of stroke in China：a result from

the Kailuan study[J]. Plos One，2013，8（4）：e61665.

[5] ZHOU D H，WANG J Y，LI J，et al. Frequency

and risk factors of vascular cognitive impairment

three months after ischemic stroke in China：the

Chongqing stroke study[J]. Neuroepidemiology，

2005，24（1-2）：87-95.

[6] SANPHAAN L，DE LEEUW F E. Poststroke

memory function in nondemented patients：a

systematic review on frequency and neuroimaging

correlates[J]. Stroke，2007，38（1）：198-203.

[7] 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（2）：236-247.

[8] CRICHTON G E，ELIAS M F，DAVEY A，et al.

Higher HDL cholesterol is associated with better

cognitive function：the maine-syracuse study[J]. J

Int Neuropsychol Soc，2014，20（10）：961-970.

[9] TANG W K，CHAN S S，CHIU H F，et al.

Frequency and clinical determinants of post-stroke

cognitive impairment in nondemendted stroke

patients[J]. J Geriatr Psychiatry Neurol，2006，19

（2）：65-71.

[10] VILA J F，BALCARCE P E，ABIUSI G R，et al.

Improvement in motor and cognitive impairment

after hyperbaric oxygen therapy in a selected

group of patients with cerebrovascular disease：a

prospective single-blind controlled trial[J]. Undersea

Hyperb Med，2005，32（5）：341-349.

[11] TERVO S丆KIVIPELTO M丆HANNINEN T丆et

al. Incidence and risk factors for mild cognitive

impairment丗A population-based three-year followup

study of cognitively healthy elderly subjects[J].

Dement Geriatr Cogn Disord丆2004丆17乮3乯丗196-

203.

[12] BLUM S丆LUCHSINGER J A丆MANLY J J丆et

al. Memory after silent stroke丗hippocampus and

infarcts both matter[J]. Neurology丆2012丆78乮1乯丗

38-46.

[13] INZITARI D丆DI CARLO A丆PRACUCCI G丆et al.

Incidence and determinants of post stoke dementia

as defined by an informant interview method in a

hospital-based stroke registry[J]. Stroke丆1998丆29丗

2087-2093.

[14] ONADJA Y丆ATCHESSI N丆SOURA B A丆et al.

Gender differences in cognitive impairment and

mobility disability in old age丗a cross-sectional study

in Ouagadougou丆Burkina Faso[J]. Arch Gerontol

Geriatr丆2013丆57乮3乯丗311-318.

[15] ONADJA Y丆BIGNAMI S丆ROSSIER C丆et al. The

components of self-rated health among adults in

Ouagadougou丆Burkina Faso[J]. Population Health

Metrics丆2013丆11乮1乯丗1-12.

[16] NEWMAN G C丆BANG H丆HUSSAIN S I丆et

al. Association of diabetes丆homocysteine and

HDL with cognition and disability after stroke[J].

Neurology丆2007丆69乮22乯丗2054-2062.

[17] COTMAN C W丆BERCHTOLD N C丆CHRISTIE

L A. Exercise builds brain health丗key roles of

growth factor cascades and inflammation[J]. Trends

Neurosci丆2007丆30丗464-472.

[18] SUZUKI T丆SHIMADA H丆MAKIZAKO H丆et al.

A randomized controlled trial of multicomponent

exercise in older adults with mild cognitive

impairment[J]. Plos One丆2013丆8乮4乯丗e61483.

[19] HEBERT R丆LINDSAY J丆VERREAULT R丆et al.

Vascular dementia丗incidence and risk factors in the

Canadian study of health and aging[J]. Stroke丆2000丆

31乮7乯丗1487-1493.

[20] LEVINE D A丆HAAN M N丆LANGA K M丆et al.

Impact of gender and blood pressure on post-stroke

cognitive decline among older latinos[J]. J Stroke

Cerebrovasc Dis丆2013丆22乮7乯丗1038-1045.

[21] BISCHKOPF J丆BUSSE A丆ANGERMEYER M C.

Mild cognitive impairment a review of prevalence丆

incidence and outcome according to current

approaches[J]. Acta Psychiatr Scand丆2002丆106乮6乯丗

403-414.