脑梗死患者认知功能障碍的评价

目的探讨血管性认知功能障碍临床特点.方法对30例脑梗死性痴呆患者、30例无痴呆的脑梗死患者和30例正常对照者,应用简明精神状态量表(Mini-Mental State Examination,MMSE)、痴呆简易筛查量表(Bfief Screening Scalefor Dementia,BSSD)和CLOX画钟试验评价认知功能,采用电生理技术检测事件相关电位P300.结果血管性痴呆组MMSE、BSSD和CLOX画钟试验评分显著低于脑梗死组和正常对照组(P＜0.01).脑梗死组MMSE、BSSD和CLOX画钟试验评分显著低于正常对照组(P＜0.01或P＜0.05),CLOXl评分的差异尤其明显.血管性痴呆组物体命名和言语复述评分与脑梗死组比较无显著差异(P＞0.05),物体命名评分与正常对照组比较也无显著差异(P＞0.05),其余MMSE各项粗分均低于脑梗死组和正常对照组(P＜0.01).脑梗死组言语复述、注意、计算和短时记忆评分显著低于正常对照组(P＜0.01),其余MMSE各项粗分与正常对照组比较无显著差异(P＞0.05).血管性痴呆组与脑梗死组和正常对照组比较,脑梗死组与正常对照组比较,P300峰潜伏时显著延长(P＜0.01).结论脑梗死患者存在不同程度的认知功能损害,血管性痴呆是认知障碍发展到严重阶段的表现,执行功能障碍是血管性认知功能损害的早期和突出的表现.

Assessment of cognitive impairment in patients with cerebral infarction

Objective To investigate the clinical characteristics of vascular cognitive impairment. Methods The cognitive functions in 30 patients with vascular dementia induced by cerebral infarction, 30 patients with cerebral infarction but without dementia, and 30 normal subjects were tested with Mini Mental State Examination (MMSE), Brief Screening Scale for Dementia (BSSD), and clock drawing task. Event related potential P 300 was measured in all subjects. Results The scaled scores of MMSE, BSSD, and clock drawing task in the vascular dementia group were significantly lower than those in the cerebral infarction group and the normal control group ( P <0.01). The scaled scores of MMSE, BSSD, and clock drawing task in the cerebral infarction group were significantly lower than those in the normal control group ( P <0.01 or P <0.05), and the difference of CLOX1 score between the two groups was more obvious. No significant difference in scores of object naming and verbal retrieval was found between the vascular dementia group and the cerebral infarction group ( P >0.05), nor between the vascular dementia group and the normal control group ( P >0.05). Other raw scores of MMSE in the vascular dementia group were lower than those in the cerebral infarction group and the normal control group ( P <0.01). Scores of verbal retrieval, attention, calculation, and short term memory in the cerebral infarction group were lower than those in the normal control group ( P <0.01), but no significant difference in the other raw scores of MMSE was found between the two groups ( P >0.05). P 300 peak latency in the vascular dementia group prolonged significantly as compared with that in the cerebral infarction group and the normal control group ( P <0.01). P 300 peak latency was also prolonged significantly in the cerebral infarction group as compared with that in the normal control group ( P <0.01). Conclusion Patients with cerebral infarction may have various degrees of cognitive impairment. Vascular dementia is the most severe manifestation of cognitive impairment. The disorder of executive function is the early and marked manifestation of cognitive impairment in patients with cerebral infarction.