轻型脑梗死及短暂性脑缺血发作患者急性期认知功能的变化及影响因素分析

column:Changes in cognitive function in patients with minor ischemic stroke and transient ischemic attack

摘要:

目的 探讨急性期轻型脑梗死及短暂性脑缺血发作（TIA）患者认知功能变化特点及相关影响因素。方法 连续筛查发病时间在7 d内的轻型脑梗死（NIHSS评分≤ 5）及TIA患者，共纳入123例患者，收集患者一般临床资料，采用蒙特利尔认知评估量表（MoCA）北京版评估患者认知功能，入院后1 d内进行首次评估，14 d后进行二次评估。根据两次认知功能评估评分变化分为改善组（评分增加值≥ 2）及未改善组，分析影响患者急性期认知功能改善的因素。结果 首次评估认知功能正常35例（28.5%），认知功能障碍88例（71.5%），14 d后认知功能正常45例（36.6%），认知功能障碍78例（63.4%）；认知功能改善62例（50.4%）（改善组），认知功能未改善61例（49.6%）（未改善组）；与首次评估相比，患者14 d后MoCA评分较前改善，差异有统计学意义（P <0.05）；其中以视空间与执行功能、命名、抽象、延迟回忆及记忆改善最为明显（P <0.05）；单因素分析显示认知功能改善组与未改善组在年龄、静息性腔梗构成比、脑萎缩构成比比较，差异有统计学意义（P <0.05），二分类变量的Logistic回归分析示既往静息性腔梗是认知功能无改善的危险因素［R=2.785（95% CI：1.248，6.212），P =0.012］。结论 多数轻型脑梗死与TIA患者发病时存在认知功能障碍，半数患者急性期内认知功能即有所改善，静息性腔梗是急性期轻型脑梗死及TIA患者认知功能无改善的独立危险因素。

Abstract:

Objective To investigate the factors affecting the improvement of cognitive function in patients with acute minor ischemic stroke (NIHSS score ≤ 5) and transient ischemic attack.Methods Patients with acute minor ischemic stroke and TIA were collected continuously. A total of 123 patients were enrolled within 7 days after the onset of the illness. MoCA Scale(Beijing version) was used to assess first scores for patients after admission and were reassessed after 14 day. According to the changes of MoCA scores within two weeks, the patients were divided into cognitive improvement group and non-improvement group. Compared with first assessment, patients with improved MoCA score of ≥ 2 were divided into improvement group, and the remaining patients were non-improved group. Clinical data related to cognitive improvement in patients were analyzed during the acute phase.Results There were 35(28.5%) patients in normal group and 88(71.5%) in the cognitive impairment group at the first assessment. After two weeks, 45(36.6%) patients were in the cognitive normal group, and 78(63.4%) in the cognitive impairment group. At the second assessment, cognitive function improvement group included 62 (50.4%) patients, and 61 patients in non-improvement group (49.6%). Compared with the first level, the MoCA scores improved after two weeks, and the difference was statistically significant (P < 0.05). The statistical analysis of the individual scores of the MoCA scale showed that the patient's visual space and executive function, naming, abstraction, and delayed recall were the most obviously improved (P < 0.05). Cognitive impairment improvement group and non-improvement group univariate analysis showed age, silent lacunar infarction, and brain atrophy were risk factors for non-improvement of cognitive impairment (P < 0.05). Logistic regression analysis showed that the silent lacunar infarction [R = 2.785 (95% CI: 1.248, 6.212), P = 0.012] was a risk factor for no improvement in cognitive function.Conclusion Most patients with acute minor stroke and TIA had cognitive dysfunction, about half of patients had improved cognitive function in the acute phase; silent lacunar infarction is a risk factor for poor prognosis in patients with acute minor ischemic stroke and TIA.