老年急性脑梗死合并脑白质疏松症患者的认知功能障碍研究

目的 探讨老年急性脑梗死（ACI）合并脑白质疏松症（LA）患者的认知功能障碍.方法 选择ACI患者128例,依据是否合并LA分为ACI＋LA组（n=76）和ACI组（n=52）,采用脑梗死牛津郡社区脑卒中项目 （OCSP）分型标准将所有ACI患者分4亚型.采用蒙特利尔认知量表（MoCA）北京版进行评分,确定ACI患者是否发生认知障碍并分为认知障碍组（n=57）和非认知障碍组（n=71）,依据Aharon-Ptretz等的标准将脑白质疏松症分为5级,搜集相关临床资料并统计分析.结果 ACI＋LA患者平均MoCA评分为（20.78±4.71）分,显著低于ACI组的（26.45±5.02）分.对LA分级后比较发现ACI＋LA组患者（1~4级）的MoCA评分显著低于ACI组患者（0级）,组间比较发现1级患者MoCA评分显著高于4级、3级;单因素分析发现梗死部位、脑白质疏松在认知障碍组和非认知障碍组中具有显著差异.多因素分析发现梗死部位和脑白质疏松均对认知功能障碍发生造成影响.结论 脑梗死的部位和脑白质疏松均是认知功能障碍发生的独立危险因素,其中梗死部位较脑白质疏松更重要.

Cognitive dysfunction in elderly patients with acute cerebral infarction and leukoaraiosis

Objective To investigate the cognitive dysfunction in elderly patients with acute cerebral infarction （ACI） and leukoaraiosis （LA）. Methods One hundred twenty- eight ACI patients were collected and divided into ACI ＋ LA group （n = 76） and ACI group （n = 52 ） in accordance with whether they had LA. All patients were classified into four subtypes of ACI according to Oxfordshire Community Stroke Pro- ject （OCSP） classification. Beijing Version of the Montreal Cognitive Assessment （MoCA） was used to determine cognitive impairment and the patients were further divided into cognitive impairment group （n = 57 ） and non -cognitive impairment group （n = 71 ）. LA was graded according to Aharon - Ptretz standard. Relevant clinical data was collected and statistically analyzed. Results An average score of MoCA in ACI ＋ LA group （20.78 ±4.71 ） was significantly lower than the ACI group （26.45 ± 5.02）. Comparison of MoCA score in different grades of LA found that MoCA score in ACI ＋ LA group （grade 1 to 4） was significantly lower than ACI group （grade 0）. Comparison between each subgroup found that MoCA score in grade 1 patients was significantly higher than grade 3 and grade 4 patients. Univariate analysis showed there were significant differences in infarction location and LA between cognitive and non - cognitive impairment group. Multivariate analysis showed both infarction loca- tion and LA affected cognitive dysfunction. Conclusion Infarction location and LA are independent risk factors for cognitive dysfunction, with in- farction location more important than LA.