脑卒中急性期认知特点

目的 探讨急性脑卒中后认知损害的特点.方法 2008年3月～2009年12月在宣武医院神经内科住院的128例发病3周内的急性脑卒中患者,皮层梗死46例,皮层出血15例,皮层下梗死49例,皮层下出血18例,所有患者均在入组当日进行一次神经心理学测试,对照组77例,完成一次神经心理学测试.结果 56％患者出现了至少一个认知域的损害,40.6％患者出现执行功能障碍,37.5％患者出现视空间结构能力的损害,26.6％患者出现记忆力障碍.左侧半球病变记忆力、执行功能和信息处理速度得分均较右侧半球病变差(P＜0.05),而视空间结构能力评分,右侧半球较左侧半球差(P＜0.05).结论 脑卒中急性期最常出现的认知损害是执行功能,所以我们建议在急性脑卒中早期尽量进行包括执行功能在内的涉及多个认知域的神经心理测验,以期较全面地了解急性脑卒中患者的认知情况,以便进行针对性的治疗.

Cognitive characteristics of patients with acute stroke

Objective To investigate the characteristics of cognitive impairment in patients after acute stroke. Methods There were a total of 128 patients in the study group,among them 46 had cortical infarction , 15 had cortical hemorrhage,49 had subcortical infarction and 18 had subcortical hemorrhage. All the patients enrolled were within three weeks of stroke onset. A series of neuropsychological test were performed at the day of enrollment. There were 77 subjects received same neuropsychological test as the normal control group. Results 56%of the patients had damage to at least one cognitive domain, 40.6% of patients with executive dysfunction,37.5% of patients with impaired capacity as visual--spatial structure, 26. 6% of patients with memory disorders. Left hemisphere lesions memory, executive function and information processing speed score worse than right hemisphere lesions （P 〈 0.05）. The test score of visual-- spatial structure in the right hemisphere were worse than those in the left hemisphere （P 〈 0.05）. Conclusions Most common acute stroke cognitive impairment is executive function, so we recommend neuropsychological tests including executive function as early as possible,in order to obtain a more comprehensive understanding of the cognitive conditions in acute stroke patients therefore to provide targeted therapy to the patients.