【作者】 谢峥；

【导师】 黄丽娜；

【作者基本信息】 河南科技大学 ， 神经病学， 2010， 硕士

【摘要】 目的:研究急性腔隙性脑梗死认知功能障碍及其演变。方法:在一家三级甲等教学医院前瞻性选取首次发病、病程< 2周的腔隙性脑梗死(lacunar infarction, LI)患者,同时选取正常人作为对照组。发病72 h内分别应用简易智力状态检查量表(mini-mental state examination, MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)进行认知功能评定,并予1个月、3个月、6个月时进行上述神经心理测试的随访。采用SPSS13.0软件包对各项指标进行分析统计,P<0.05为差异有统计学意义。结果:1.共纳入LI患者70例,60例正常人作为对照。受试者中基底节16例、丘脑14例、脑干10例、侧脑室旁18例和半卵圆中心12例,其中25例(36%)出现了不同程度的认知功能障碍。2. Logistic回归分析显示LI患者认知功能障碍的出现与高血压、糖尿病、高脂血症及高同型半胱氨酸血症(hypercholesterolemia, HHcy)有关(P<0.05)。3.与正常对照组比较,基底节、丘脑、脑干、侧脑室旁和半卵圆中心五个部位无论是在MoCA总分,还是视空间技能与执行功能、注意、语言、抽象和延迟回忆因子评分具有显著差异(P<0.05),而计算、命名和定向力无显著差异(P>0.05)。基底节、丘脑、脑干、侧脑室旁和半卵圆中心五个部位之间比较:(1)延迟回忆:丘脑、基底节与其余三个部位比较具有显著差异(P<0.05);(2)语言:丘脑、基底节与其余三个部位比较有显著差异(P<0.05);(3)视空间与执行功能:基底节与其余四个部位比较具有显著差异(P<0.05);(4)注意力:脑干与其余四个部位比较具有显著差异(P<0.05)。4.与72 h认知功能相比,LI患者在随访的1个月、3个月和6个月时的注意力评分均明显改善(P<0.05),基本恢复至正常对照组水平。视空间技能与执行功能、语言、延迟回忆评分虽有好转,6个月后仍与正常对照组有明显差异(P<0.05),恢复较差。结论:1.首次发病的LI常可出现认知功能障碍,高血压、糖尿病、高脂血症及高同型半胱氨酸血症与认知功能障碍的出现密切相关。2.病灶部位是LI患者出现认知功能受损的重要因素,病灶体积与认知功能无明显关系。病变部位多在基底节、丘脑、脑干、侧脑室旁和半卵圆中心,其中,基底节、丘脑对认知功能的影响最大,主要累及视空间技能与执行功能、语言和延迟回忆。3. LI发病急性期对认知影响最大,随后认知状况可部分恢复,注意力恢复较好;而视空间与执行、语言和延迟回忆恢复差。6个月后仍可遗留不同程度的认知功能障碍。提示急性LI与认知功能障碍关系密切,值得重视和早期干预。更多还原

【Abstract】 Objectives: To investigate the characteristics of cognitive impairment on patients with acute first-ever lacunar infarction and its evolution. Methods: In a 3A-level teaching hospital, the cognitive performance was prospectively assessed in patients with acute first-ever lacunar infarction and the normal control. The neuropsychological tests included the mini-mental state examination (MMSE) and the scale of Montreal Cognitive Assessment (MoCA). The relationship between the cognitive impairment and lesion location was analyzed, and the risk factors of cognitive impairment were evaluated. The neuropsychological tests were revaluated at 1st month, 3rd month and 6th month. Statistical analyses were performed with the software package of SPSS13.0, with 2-taile P<0.05 considered statistically efficient. Results: 1. 70 patients with acute first-ever lacunar infarction and 60 normal control were selected in the study. Based on the lesion, there were 16 basal ganglia, 14 thalamus, 10 brainstem, 18 periventricular location, 12 corona radiate in 70 patients. 25 LI patients experienced cognitive impairment (36%).2. By logistic regression analysis, the result showed that the onsets of cognitive impairment had correlation with hypertension, diabetes mellitus, hypercholesterolemia and hyperhomocysteinemia (P<0.05).3. Compared with control subject, patients with lesion locations in basal ganglia, thalamus, brainstem, periventricular location, corona radiate had significantly lower scores in visual spatial and executive function, attention, language, abstraction and memory factors(P<0.05); but no significant difference in calculation, naming and orientation factors(P>0.05). Comparisons between the five lesion locations:(1)patients with lesions in basal ganglia, thalamus had significantly low scores in memory compared with other three lesion locations (P<0.05); (2)patient with lesions in basal ganglia, thalamus had also significantly lower scores in language compared with other three lesion locations (P<0.05);(3) patients with lesions in basal had significantly lower scores in visual spatial and executive function compared with other four lesion locations (P<0.05);(4)The patients with lesions in brainstem performed poorer in attention factor score compared with other four lesion locations (P<0.05).4. During the follow-up, there were significantly differences in the scores of attention 1month, 3 month, 6 month after attack compared with 72 hours’, which had reached normal level of the control (P<0.05). Significant differences was found between the control and patients with LI after 6 months in scores of visual spatial and executive function, language, abstraction and memory factors(P<0.05), though it showed a favorable turn. It seemed improved poorly after LI.Conclusions: 1. First-ever lacunar infarction usually undergo vascular cognitive impairment. It is closely related to multiple factors, such as hypertension, diabetes mellitus, hypercholesterolemia and hyperhomocysteinemia.2. The location of lesion is considered important factor contributing to cognitive impairment, but there is no significant relationship between cognitive dysfunction and ischemic location volume. The ischemic lesions are found in basal ganglia, thalamus, brainstem, periventricular location as well as corona radiate. The location of lesions in basal ganglia, thalamus can lead to cognitive impairments, especially in language, memory, visual spatial and executive function.3. LI in acute stage can cause cognitive impairment which improve partly after stoke, with an excellent benign prognosis for recovery in attention but poor in memory, visual spatial and executive function. Patients with LI may undergo varying severity of cognitive impairments for 6 moths after they discharge from hospital. There are mild to severe cognitive dysfunction in the first-ever diagnosed LI patients, which need pay attention to and intervene in time.更多还原