【摘要】：目的:通過對缺血性腦卒中急性期患者進行全面神經(jīng)心理學評估,對其進行以癥狀學為基礎的新型分型,并探討不同分型之間流行病學、影像學及神經(jīng)功能損害程度的差異。以便更好地識別血管性認知障礙,并及時給予相應的臨床干預,改善預后。方法:連續(xù)收集2013年11月-2014年11月浙江大學附屬第一醫(yī)院神經(jīng)內(nèi)科和嘉興市第二醫(yī)院神經(jīng)內(nèi)科收治的符合納入和排除標準的急性缺血性腦卒中患者208例,依次記錄患者的年齡、性別、受教育年限、既往史、入院時的美國國立衛(wèi)生院卒中量表評分和改良Rankin量表分級、實驗室檢查以及影像學情況,并采用簡易精神狀態(tài)量表、阿爾茲海默病評定量表認知分量表、臨床癡呆量表等量表評估患者認知功能,根據(jù)美國國立疾病與卒中研究所和瑞士神經(jīng)科學研究國際協(xié)會和美國心臟協(xié)會/美國卒中協(xié)會有關血管性癡呆和血管性輕度認知障礙診斷標準,將血管性癡呆及血管性輕度認知障礙臨床結果分為"1.很可能,2.可能,3.肯定,4.否",將同時滿足血管性癡呆及血管性輕度認知障礙為"否"的患者納入認知功能正常組,將患者分為認知功能正常組及血管性認知障礙組,其中血管性認知障礙組按阿爾茲海默病評定量表認知分量表評分中語言、操作、記憶三個領域評分的中位數(shù)為標準進行癥狀學分型,可分成記憶損傷為主型、語言損傷為主型、操作損傷為主型、混合型。采用SPSS22.0統(tǒng)計軟件進行統(tǒng)計學分析,比較各亞型之間的基線特征、影像學特征及入院時神經(jīng)功能缺損情況。結果:缺血性卒中急性期患者按認知障礙癥狀學特點分為五型:正常型61例(29.33%);記憶損傷為主型10例(4.81%);語言損傷為主型35例(16.83%),操作損傷為主型14例(6.73%);混合型88例(42.31%)。各型在年齡、受教育年限、性別間差異具有統(tǒng)計學意義(P0.05),而在糖尿病、高血壓病、高脂血癥及卒中史間差異不具有統(tǒng)計意義(P0.05);各型在梗死部位和梗死數(shù)量上差異無統(tǒng)計學意義(P0.05);各型在入院時改良Rankin量表分級和美國國立衛(wèi)生院卒中量表評分比較(P=0.298,P=0.403),差異均無統(tǒng)計學意義(P0.05)。結論:缺血性卒中急性期患者大多存在認知障礙,本研究發(fā)現(xiàn)血管性認知障礙按癥狀學可分為五型,該分型反映血管性認知障礙的異質性:認知功能損害的不同領域隨年齡變化有各自的特點,年齡越大,其對記憶、注意和視空間能力的損傷越大,對語言的影響則相對較小。而受教育水平可能更多地影響語言的抽象和概括能力,與注意、記憶功能的關系不大。男性在操作上優(yōu)于女性,但在記憶和語言上更容易受損害;各亞型間影像學征象和神經(jīng)功能缺損等并無明顯差異,需要進一步研究各癥狀缺損機制以幫助針對性神經(jīng)康復。
[Abstract]:Objective: to evaluate the patients with acute ischemic stroke by comprehensive neuropsychological evaluation, and to explore the difference of epidemiological, imaging and neurological impairment among different types. In order to better identify vascular cognitive impairment and give corresponding clinical intervention in time to improve prognosis. Methods: 208 patients with acute ischemic stroke who met the inclusion and exclusion criteria were collected from November 2013 to November 2014 in the Department of Neurology, the first affiliated Hospital of Zhejiang University and the Department of Neurology, Jiaxing second Hospital. The patient's age, sex, years of education, past history, National Hospital Stroke scale score and modified Rankin scale rating, laboratory examination and imaging status were recorded in turn, and a simple mental state scale was used. Alzheimer's disease rating scale cognitive subscale, clinical dementia scale and other scales to evaluate the cognitive function of patients, According to the National Institute of Disease and Stroke and the Swiss International Association for Neuroscientific Research and the American Heart Association / American Stroke Association for the diagnosis of vascular dementia and vascular mild cognitive impairment, The clinical results of vascular dementia and vascular mild cognitive impairment were divided into "1. It is likely that, 2. Maybe, 3. Sure, 4. No, the patients who met both vascular dementia and vascular mild cognitive impairment were included in the normal cognitive function group, and the patients were divided into normal cognitive function group and vascular cognitive impairment group. Among them, the vascular cognitive impairment group was divided into memory impairment type and language injury type according to the median score of language, operation and memory in the cognitive subscale of Alzheimer's disease rating scale. Operation damage is the main type, mixed type. SPSS22.0 statistical software was used for statistical analysis, and the baseline features, imaging features and neurological deficit at admission were compared. Results: according to the symptomatic characteristics of cognitive impairment, the patients with acute ischemic stroke were divided into five types: normal type in 61 cases (29.33%), memory impairment in 10 cases (4.81%), and memory impairment in 10 cases (4.81%). Language injury was the main type in 35 cases (16.83%), operation injury in 14 cases (6.73%) and mixed type in 88 cases (42.31%). There were significant differences in age, years of education and gender (P 0.05), but there was no significant difference in diabetes, hypertension, hyperlipidemia and stroke history (P 0.05). There was no significant difference in the location and number of infarction among each type (P 0.05). There was no significant difference between the improved Rankin scale on admission and the National Hospital Stroke scale score (P 鈮，

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