脑皮质下小血管梗塞后认知功能损害的恢复及其影响因素

目的 研究脑皮质下小血管梗塞（SSVI）后12周认知功能恢复的发生率、行为神经病学特点及认知功能恢复的影响因素。方法 采用前瞻性队列研究方法，选取首次发病，病程〈2周的SSVI患者60例，同时选取日常生活能自理的社区老年人52例作为对照组。SSVI后2和12周采用简易精神状态检查（MMSE）量表与洛文斯顿认知功能成套测验（LOTCA，包括LOTCA总分、定向力、视空间能力及执行功能）进行认知功能评分，并进行神经功能缺损及日常生活能力评价（修订版Barthel指数，MBI）。分析影响各类型认知功能恢复的因素。比较各类型认知功能恢复与未恢复患者日常生活能力的差异。结果 ①SSVI后2周内共有44例患者出现认知功能损害，与SSVI后2周比较，SSVI后12周MMSE、定向力、视空间能力、执行功能评分及LOTCA总分均有所改善，但除定向力评分恢复至对照组水平外（P〉0．05），其余各项评分仍低于对照组水平（P〈0．01）；恢复率分别为36．8％（14／38）、87．5％（14／16）、33．3％（4／12）、26．1％（12／46）及30．2％（13／44）。②多因素Logistic回归分析显示，男性（OR：3．49，95％CI：1．18～7．81）与SSVI后12周MMSE评分有关；受教育程度（初中及其以上，OR=2．53，95％CI：1．23～6．87）及脑白质病变（OR=0．23，95％CI：0．07—0．79）与执行功能评分有关。③与SSVI后2周比较，SSVI后12周NIHSS评分差异无统计学意义（P〉0．05）；而MBI评分显著提高，差异有统计学：鼓义（P〈0．05）；SSVI后12周，在各类型认知功能中，仅执行功能及LOTCA总分恢复者与未恢复者之间，MBI评分差异有统计学意义（P〈0.05）。结论 SSVI后12周各类型的认知功能均有显著的改善。但大部分患者仍存在某一类型的认知功能损害。执行功能的恢复有助于日常生活能力的提高。男性是MMSE总分恢复?

Recovery of cognitive impairment and its influencing factors in patients after subcortical small vessel disease

Objective To explore the incidence, the features of behavioral neurology and the influencing factors of cognitive function recovery in patients at 12 weeks after subcortical small vessel infarction （SSVI）. Methods Sixty patients with first attack of SSVI, whose course of disease was 〈 2 weeks, were selected by using the prospective cohort study, and 52 elderly person were selected as the control group. Cognitive function scores were performed by using mini-mental state examination （MMSE） and Loewenstein occupational therapy cognitive assessment （LOTCA） （including LOTCA total score, orientation, visual-spatial ability, and executive function） were performed 2 and 12 weeks after SSVI. The neurological impairment and activities of daily living were evaluated. All factors influencing cognitive function recovery were analyzed. The differences of daily living ability in patients with full recovery of not of cognitive function were compared. Results ①A total of 44 patients had cognitive impairment within two weeks after SSVI. The scores of MMSE, orientation, visual-spatial ability, executive function and LOTCA total score were improved 12 weeks after SSVI, as compared with those at two weeks after SSVI, the recovery rates were 36. 8% （ 14/38）, 87. 5% （ 14/16）, 33.3% （4/12）, 26. 1% （ 12/46）, 30. 2% （13/44） ,respectively. ②Multivariate Logistic regression analysis showed that the male sex（ OR 3.49; 95% CI 1.18 - 7.81） was related to the MMSE scores 12 weeks after SSVI; the education level （junior high school or above, OR 2. 53, 95% CI 1.23 - 6. 87） and white matter lesions （ OR 0. 23, 95% CI 0. 07 - 0. 79） were associated with the scores of executive function. ③There were no statistically significant differences in NIHSS scores 12 weeks after SSVI compared with those two weeks after SSVI（ P 〉 0. 05 ）, and the MBI scores increased significantly（P 〈 0.05）. Only executive function and LOTCA total score between the recovered and non-recovered patients in MBI