Influencing Factors of Mild Vascular Cognitive Impairment

doi:10.3969/j.issn.1673-5765.2019.09.005

Abstract

Abstract:

Objective To explore the influencing factors of mild vascular cognitive impairment (mVCI). Methods Patients with acute ischemic stroke within 14 days from onset who were admitted to Handan First Hospital From August 2015 to October 2018 were selected. All the patients were assessed by mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). According to the scores, these patients were divided into mVCI group and normal cognition (NCI) group. The clinical data were compared between the two groups, using univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of mVCI. Results Finally, a total of 205 patients were included in this study, with 97 cases in mVCI group and 108 cases in NCI group. The proportion of patients with low education (P =0.006), hypertension (P =0.032), diabetes (P =0.041) and smoking (P =0.026) in mVCI group were significantly higher than that in NCI group. The levels of plasma homocysteine (P =0.016), triglyceride (P =0.040), cholesterol (P =0.026) and Pittsburgh sleep quality index (P <0.001) were significantly higher in mVCI group than that in NCI group. Elevated plasma homocysteine level (OR 1.139, 95%CI 1.012- 1.283, P =0.031) and multivariate logistic regression analysis showed that poor sleep quality (OR 1.301, 95%CI 1.107-1.530, P =0.001) were independent risk factors for mVCI, and high education degree (OR 0.652, 95%CI 0.434-0.978, P =0.039) was a protective factor.

Conclusions Hyperhomocysteinemia and poor sleep quality are independent risk factors for mVCI, while high education degree is a protective factor for mVCI.

Key words: Mild vascular cognitive impairment; Risk factor; Protective factor

摘要：

目的探讨轻度血管性认知障碍（mild vascular cognitive impairment，mVCI）的影响因素。方法选取2015年8月-2018年10月收治于邯郸市第一医院神经内科的发病14 d内急性缺血性卒中的患者为研究对象，行简易精神状态检查表、蒙特利尔认知评估量表测评，对其认知功能进行评估，并根据其得分情况分为mVCI组及认知正常组。对比两组患者的临床资料的差异，采用单因素分析和多因素Logistic回归分析探讨mVCI的影响因素。结果最终共纳入205例患者，mVCI组97例,认知正常组108例。①单因素分析显示，mVCI组患者低文化程度（P =0.006）、高血压（P =0.032）、糖尿病（P =0.041）及吸烟（P =0.026）的比例显著高于认知功能正常组，差异有统计学意义。mVCI组患者的血浆同型半胱氨酸水平（P =0.016）、TG水平（P =0.040）、TC水平（P =0.026）以及匹兹堡睡眠质量指数（P＜0.001）显著高于认知正常组，差异有统计学意义。②多因素Logistic回归分析显示，同型半胱氨酸水平升高（OR 1.139，95%CI 1.012～1.283， P =0.031）和主观睡眠质量差（OR 1.301，95%CI 1.107～1.530，P =0.001）是mVCI发生的独立危险因素，而文化程度高（OR 0.652，95%CI 0.434～0.978，P =0.039）是mVCI 的保护性因素。结论高同型半胱氨酸血症及睡眠质量差是mVCI的独立危险因素，而文化程度高是mVCI的保护性因素。

关键词: 轻度血管性认知障碍; 危险因素; 保护性因素

CHEN Hong-Xia, QIU Xiao-Xue, LI Shi-Wen, SONG Yan-Li, WU Yi-Ping, LIN Jie. Influencing Factors of Mild Vascular Cognitive Impairment[J]. Chinese Journal of Stroke, 2019, 14(09): 877-881.

陈红霞, 邱晓雪, 李世文, 宋彦丽, 武一平, 林杰. 轻度血管性认知障碍影响因素分析[J]. 中国卒中杂志, 2019, 14(09): 877-881.

References

[1] 贾建平，陈生弟. 神经病学[M]. 北京：人民卫生出版

社，2013：170.

[2] QU Y，ZHUO L，LI N，et al. Prevalence of poststroke

cognitive impairment in China：a communitybased，

cross-sectional study[J/OL]. PLoS One，2014，

10（4）：e0122864. https：//doi.org/10.1371/journal.

pone.0122864.

[3] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2014[J]. 中华神经科杂志，2015，48（3）：246-248.

[4] 中华医学会神经病学分会痴呆与认知障碍学组写作

组. 血管性认知障碍诊治指南[J]. 中华神经科杂志，

2011，44（2）：142-147.

[5] PENDLEBURY S T，ROTHWELL P M. Prevalence，

incidence，and factors associated with pre-stroke and

即使在相同脑损伤情况下，卒中后认知障

碍在不同患者之间也存在较大差异，文化程

度是解释这些差异的一个潜在因素。Sylv ia

Villeneuve等[13]研究发现，接受过高等教育的

人群记忆力损伤较小。最近的一项研究报道，

高教育水平是认知功能的保护因素[14]。本研究

也显示高教育水平是mVCI的保护性因素。但

研究的结论并不完全一致，一项荟萃分析显示，

虽然既往研究发现教育水平与血管性认知障碍

相关，但其影响很小[15]。

研究显示，睡眠障碍相关症状在认知障碍

患者中较常见，其中睡眠呼吸暂停及快速眼动

期睡眠行为障碍在血管性认知障碍中更为常

见[16 -17]。最新报道指出，社区老年人睡眠质量

差及活动量减少与其认知能力下降有关[18]。还

有研究表明改善患者睡眠质量可能成为早期改

善患者认知功能及预防痴呆的一项重要干预

措施[19]。本研究结果显示，mVCI组和认知正常

组均有不同程度的睡眠质量问题，但mVCI组

夜间睡眠质量更差，提示较差的睡眠质量可能

加重患者认知损害。

本研究采用的是横断面调查方法，为单中

心较小样本量的研究，需进一步进行前瞻性研

究、随访研究评估mVCI的危险因素及干预性

治疗措施。

post-stroke dementia：a systematic review and metaanalysis[

J]. Lancet Neurol，2009，8（11）：1006-1018.

[6] SUDDUTH T L，WEEKMAN E M，PRICE

B R，et al. Time-course of glial changes in the

hyperhomocysteinemia model of vascular cognitive

impairment and dementia（VCID）[J]. Neuroscience，

2017，26（341）：42-51.

[7] CASADONARANJO I，ROMERO S R，PORTILLA

CUENCA J C，et al. Association between subclinical

carotid atherosclerosis，hyperhomocysteinaemia

and mild cognitive impairment[J]. Acta Neurologica

Scandinavica，2015，134（2）：154-159.

[8] 余招平，徐文安，洪玉娥. 脑小血管病的轻度认知损

害与同型半胱氨酸的相关性研究[J]. 山东医药，2011，

51（16）：84-86.

[9] WANG T，SUN Z W，SHAO L Q. Diagnostic values

of serum levels of homocysteine and uric acid for

predicting vascular mild cognitive impairment in

patients with cerebral small vessel disease[J/OL].

Med Sci Monit，2017，23：2217-2225. https：//doi.

org/10.12659/msm.901652.

[10] SUDDUTH T L，POWELL D K，SMITH C D，et al.

Induction of hyperhomocysteinemia models vascular

dementia by induction of cerebral microhemorrhages

and neuroinflammation[J]. J Cereb Blood Flow

Metab，2013，33（5）：708-715.

[11] SOLFRIZZI V，D INTRONO A，COLACICCP A

M，et al. Circulating biomarkers of cognitive decline

and dementia[J]. Clin Chim Acta，2006，364（1-2）：

91-112.

[12] HAINSWORTH A H，YEO N E，WEEKMAN E

M，et al. Homocysteine，hyperhomocysteinemia

and vascular contributions to cognitive impairment

and dementia（VCID）[J]. Biochimica Et Biophysica

Acta，2015，1862（5）：1008-1017.

[13] VILLENEUVE S，MASSOUD F，BOCTI C，et al.

The nature of episodic memory deficits in MCI with

and without vascular burden[J]. Neuropsychologia，

2011，49（11）：3027-3035.

[14] JIE B，PENG W，NING Z，et al. A study of

mild cognitive impairment in veterans：role of

hypertension and other confounding factors[J].

Neuropsychol Dev Cogn B Aging Neuropsychol

Cogn，2016，23（6）：703-715.

[15] KESSELS R P，EIKELBOOM W S，

SCHAAPSMEERDERS P，et al. Effect of formal

education on vascular cognitive impairment after

stroke：a meta-analysis and study in young-stroke

patients[J]. J Int Neuropsychol Soc，2017，23（3）：

223-238.

[16] GUARNIERI B，ADORNI F，MUSICCO M，et al.Prevalence of sleep disturbances in mild cognitive

impairment and dementing disorders：a multicenter

Italian clinical cross-sectional study on 431 patients.

[J]. Dement Geriatr Cogn Disord，2012，33（1）：50-

58.

[17] PISTACCHI M，GIOULIS M，CONTIN F，et

al. Sleep disturbance and cognitive disorder：

epidemiological analysis in a cohort of 263

patients[J]. Neuro Sci，2014，35（12）：1955-1962.

[18] NAKAKUBO S，MAKIZAKO H，DOI T，et al.

Impact of poor sleep quality and physical inactivity

on cognitive function in community-dwelling older

adults[J]. Geriatr Gerontol Int，2017，17（11）：1823-

1828.

[19] YAFFE K，FALVEY C M，HOANG T. Connections

between sleep and cognition in older adults[J].

Lancet Neurol，2014，13（10）：1017-1028.