急性脑梗死患者认知障碍的临床特征分析

目的探讨急性脑梗死患者认知障碍的临床特征,并分析其相关影响因素。方法采用简易精神状态检查法（MMSE）和洛文斯顿作业治疗用认知成套测验（LOTCA）进行神经心理测验,用日常生活活动能力（ADL）量表对患者ADL进行评定,神经功能缺损评分评定患者神经功能缺损程度,分析急性脑梗死患者认知障碍的临床特征。结果①260例急性脑梗死患者中有认知障碍者108例,占41.5%,主要表现为注意障碍64例（59.4%）,定向障碍37例（34.2%）,思维运作障碍45例（39.8%）,结构性失用34例（31.4%）,视失认29例（27.5%）,空间失认23例（21.3%）,空间知觉障碍18例（16.7%）,单侧忽略15例（13.9%）,图形背景分辨障碍12例（11.1%）,运动失用9例（8.3%）。②急性脑梗死患者认知障碍与病变部位、临床类型、ADL及病情程度有关,以皮质部位发生认知障碍的危险性高（OR=2.965,95%C I：1.329-6.611）;多发病灶者较单发病灶者更易发生认知障碍（OR=2.190,95%C I：1.022-4.693）;ADL越差,发生认知障碍的危险性越高（P〈0.05）;认知障碍随病情程度加重而加重（P〈0.05）。结论急性脑梗死患者常伴发认知障碍,认知障碍可多种类型共存或交叉并存。可表现为注意障碍、定向障碍、思维运作障碍、结构性失用、视失认、空间失认、空间知觉障碍、单侧忽略、图形背景分辨障碍、运动失用,其中以注意障碍最多见;急性脑梗死患者认知障碍与发生在皮质部位、多发病灶、ADL差和病情程度重等因素有关。

Clinical characteristics of cognitive impairment of patients with acute cerebral infarction patients

Objective To evaluate the clinical characteristics of cognitive impairment of patients with acute cerebral infarction and investigate the influential factors for cognitive impairment. Methods 260 patients with acute cerebral infarc- tion were examed by mini-mental state exemanation and Loewenstein occupational therapy cognitive assessment. We evalua- ted the locomotor activities of daily life of patients with cerebral infarction, and analysed the clinical characteristics of cogni- tive impairment. Results ①Of the 260 patients with acute cerebral infarction, the cognitive impairment was observed in 108 patients, with the incidence of cognitive impairment of 41.5%. The manifestations of cognitive impairment inciuded： attention disorder （31.4%） , thinking the operation of the obstacles （39.8%） , structural apraxia （31.4%） , agnosia visual （27.5%）, space agnosia （21.3%）, spatial perception of barriers （ 16.7% ）, unilateral neglect （ 13.9% ）, the background graphics to distinguish obstacles （ 11.1% ） ,sports apraxia （8.3%）. ②Cognitive impairment in acute cerebral infarction patients was related with the areas of involvement, the incidence of cortical parts was much higher than that of other parts（ OR =2. 965,95% CI：1. 329 - 6. 611 ）; Cognitive impairment in acute cerebral infarction was related with clinical patterns, the incidence of the multi-occurring pattern was higher than that of the single-occurring pattern（ OR = 2. 190,95% CI： 1. 022 -4.693） ; Cognitive impairmen in acute cerebral infarction patients was related with daily living capability. Conclu- sions ①Patients with acute cerebral infarction are often accompanied by cognitive impairment. ②The cognitive impairment is related with cortical parts, multi-occurring pattern, daily living capability getting worse and extent of the disease.