颈动脉狭窄对老年患者认知功能影响的随访研究

目的 探讨颈动脉狭窄对老年患者认知功能的影响. 方法 在第三军医大学大坪医院住院部和门诊患者中经简明智能状态量表(MMSE)筛选认知功能正常的老年患者215例,通过颈颅联合CT血管造影(CTA)和(或)数字减影脑血管造影(DSA)等方法 ,确定有无颈动脉狭窄和狭窄程度.分颈动脉重度狭窄(狭窄率≥70%)组.颈动脉中度狭窄(狭窄度30%～69%)组,颈动脉轻度狭窄(狭窄度10%～29%)组和基本正常组(狭窄度<10%),1年后采用MMSE检测认知功能及其损害,比较不同颈动脉狭窄组患者认知损害的发生情况以及认知功能下降程度. 结果 经过1年随访,颈动脉重度狭窄患者认知损害发生率(43.1%)高于颈动脉中度狭窄组(22.8%)、颈动脉轻度组(8.3%)和颈动脉基本正常组(8.7%),差异有统计学意义(P<0.05).各组MMSE评分均降低,其中颈动脉重度狭窄组MMSE评分(19.85±7.54)低于颈动脉中度狭窄组(22.71±5.73)、颈动脉轻度狭窄组(25.32±4.22)和颈动脉基本正常组(25.25±4.36),差异有统计学意义(P<0.05). 结论 颈动脉狭窄可导致老年人认知功能损害的发生.并且认知功能损害随颈动脉狭窄程度加重而加重.

Impact of carotid artery stenosis on cognitive function in elderly patients: follow-up results

Objective To assess the impact of carotid artery stenosis on the cognitive function of elderly patients. Methods A total of 215 elderly patients with normal cognitive function were recruited from the out-patients and in-patients in our department. According to the severity of carotid stenosis defined by digital subtraction angiography or CT angiography, these patients were divided into 4 groups with severe (stenosis≥70%), moderate (stenosis 30%-69%), mild (stenosis 10%-29%) carotid artery stenosis or basically normal carotid artery (stenosis 0%-9%). The patients were followed up for 1 year, and Mini-mental State Examination (MMSE) was used to evaluate the cognitive function of the 4 groups of patients at the end of the follow-up. Results At the end of the one-year follow-up, 43.1% of patients with severe carotid artery stenosis exhibited cognitive impairment, a rate significantly higher than that in patients with moderate (22%) and mild (8.3%) stenosis and the patients with basically normal carotid artery (8.7%)(P<0.05). The MMSE scores of the patients with severe, moderate, and mild carotid artery stenosis and those with normal carotid artery all decreased one year after the examination to 19.85± 7.54, 22.71±5.73, 25.32±4.22, and 25.25±4.36, respectively, and the patients with severe carotid artery stenosis had the lowest score. Conclusion Carotid artery stenosis may lead to cognitive impairment in the elderly, and the risk is positively correlated to the degree of carotid artery stenosis.