老年非瓣膜性心房颤动患者脑卒中前认知功能的临床特点分析

目的探讨合并非瓣膜性心房颤动(房颤)的老年脑卒中患者首发脑卒中前认知功能的临床特点。方法选取老年急性脑卒中患者540例,伴有非瓣膜性房颤患者87例(房颤组),无房颤患者453例(对照组)。收集患者人口学资料,并于入院或就诊后2d内完成神经心理学量表,简易智能状态检查量表(MMSE)、美国国立卫生研究院卒中量表(NIHSS)及简化版老年认知功能减退知情者问卷IQCODE)测评,比较2组资料并做统计学分析。结果540例老年急性脑卒中患者中,77例(14.3%))脑卒中前有认知功能障碍,9例(1.7%)达到痴呆。房颤组年龄、糖尿病、血管疾病,抗凝药、NIHSS评分、IQCODE评分、IQCODE≥3.44分、IQCODE≥4分比例明显高于对照组,抗血小板药、MMSE评分明显低于对照组,差异有统计学意义(P0.05,P0.01)。logistic回归分析显示,急性脑卒中患者年龄、房颤和糖尿病为脑卒中前认知功能障碍的危险因素(P0.05,P0.01),房颤组患者年龄和持续性房颤为脑卒中前认知功能障碍的危险因素(OR=1.144,95%CI:1.039~1.259,P=0.006;OR=6.843,95%CI:1.936~24.195,P=0.003)。结论房颤患者脑卒中前认知功能已有损害,并随着年龄的增大而增加,房颤是老年脑卒中患者认知功能减退的独立危险因素,要重视对房颤患者的认知功能评估。     

脑梗死患者颈动脉粥样硬化对认知功能障碍的相关性分析

目的探讨颈动脉内膜中层厚度、动脉壁粥样斑块形态大小及相关因素对脑梗死患者认知功能状态的影响。方法采用韦氏记忆测试量表,对急性脑梗死3个月后的280例患者进行神经心理学测试,确诊认知功能障碍32例;通过匹配年龄、性别及脑梗死部位及大小,选择同时期认知功能正常的脑梗死患者32例作为对照组;应用血管二维超声技术检测颈内动脉内膜中层厚度、动脉壁粥样斑块形态大小,同时检测相关的可能危险因素;比较两组的差异,分析影响脑梗死患者认知功能障碍的独立危险因素。结果认知功能障碍组与对照组危险因素比较,两组在高血压持续时间、颈动脉内膜中层厚度、双颈动脉斑块总面积、双颈动脉软斑块面积、胆固醇、血糖、叶酸等有显著性差异(P<0.05)。剔除高血压持续时间、总胆固醇等因素,双颈动脉斑块总面积仍是脑梗死认知功能障碍的危险因素(Exp(B)=1.684,95%CI为1.304-2.179,P<0.01)。结论颈动脉壁斑块形态及大小可能是导致急性脑梗死3个月后认知功能障碍的独立危险因素。     

空腹血糖调节受损与老年人认知功能障碍关联性分析

目的探讨空腹血糖调节受损(IFG)与老年人认知功能障碍之间的关系。方法采用横断面研究,以简易智能状态量表评估认知功能,并运用多因素回归分析IFG与认知的关联性。结果共纳入研究对象186例,其中认知功能障碍者70例。单因素分析显示:年龄、性别、教育年限、高血压及IFG与老年人认知功能障碍有关。多因素分析显示年龄、性别及IFG是老年人认知功能障碍的危险因素。结论IFG是老年人认知功能障碍的独立危险因素,对其早期诊断和治疗可能改善老年人的认知功能情况。     

心房颤动与认知功能障碍密切相关

心房颤动(简称房颤)是痴呆相关的高危独立因素。房颤影响认知功能障可能的潜在机制是微血栓和或微小出血的重复损伤、脉率和脑血管灌注变化导致微血管病变、炎性状态的长期存在、共同的遗传危险因素,但通过抗凝治疗、控制心室率治疗、射频消融手术的影响、他汀类药物可降低认知功能障碍的发生率。     

血管危险因素与老年认知功能障碍的研究进展

血管危险因素与老年认知功能障碍的发生密切相关。由血管危险因素引起的老年认知功能障碍的发病率逐年上升,严重危害老年人的健康。高血压、糖尿病、高脂血症和慢性脑低灌注等是影响老年认知功能的重要的血管危险因素。研究血管危险因素与老年认知功能障碍的关系及作用机制,对于老年认知功能障碍的早期诊断和早期干预,具有重要的社会学和医学意义。     

老年科住院患者认知功能减退相关因素分析

目的:探讨老年患者认知功能减退的可能影响因素,以便通过对部分相关因素的早期干预,减少、延缓老年人认知功能的衰退。方法:使用蒙特利尔认知评估量表(Mo CA)对我院老年科202例患者进行认知功能评估,分为认知功能减退组与认知功能正常组。分析可能影响因素与认知功能的相关性。结果:202例患者中认知功能减退组142例(70.3%),认知功能正常组60例(29.7%)。年龄、文化程度、高血压、糖尿病、高脂血症、心房颤动(房颤)、颈动脉粥样硬化2组间差异有统计学意义(均P0.05)。多因素Logistic回归分析提示,年龄[比值比(OR)=4.407,95%可信区间(CI):2.084~9.320]、高血压(OR=7.597,95%CI:2.478~23.297)、糖尿病(OR=2.975,95%CI:1.191~7.428)、高脂血症(OR=8.977,95%CI:2.913~27.659)、颈动脉粥样硬化(OR=4.400,95%CI:1.636~11.836)、房颤(OR=3.183,95%CI:1.059~9.566)是认知功能减退的危险因素,而文化程度(OR=0.305,95%CI:0.153~0.607)是认知功能的保护因素。结论:老年人群中认知功能减退发生率较高。年龄、高血压、糖尿病、高脂血症、颈动脉粥样硬化、房颤均是认知功能减退的危险因素,而文化程度是认知功能的保护因素。     

轻中度颅脑损伤患者认知功能障碍特征及危险因素

目的研究轻中度创伤性颅脑损伤(TBI)患者认知功能障碍的特点及相关危险因素,为早期诊断和采取有针对性的治疗及康复训练提供依据。方法前瞻性研究2014年9月至2015年9月新乡医学院第一附属医院收治的轻中度TBI患者102例,采用蒙特利尔认知评估量表(Mo CA)中文版评定其认知功能,根据评定结果分认知功能障碍组和无认知功能障碍组,分析年龄、性别、文化程度等因素与认知功能障碍之相关性;根据损伤部位不同分组,分析不同损伤部位患者之间认知功能障碍程度的差异。结果纳入研究的102例中,认知功能障碍74例(72.5%),认知功能障碍以视空间与执行功能、注意力、计算力、语言、抽象、延迟回忆等认知域为重(均P0.01)。额叶、颞叶和基底节损伤的患者发生认知功能障碍的程度较其他部位严重(均P0.05)。Logistic回归分析显示,文化水平、年龄是影响TBI后认知功能障碍的主要危险因素(均P0.01)。结论额叶、颞叶和基底节部位损伤患者的认知功能障碍程度较重,文化程度、年龄是轻中度TBI后认知功能障碍的主要危险因素。     

血清羧化不全骨钙素在老年2型糖尿病患者认知功能评估中的意义

目的分析血清羧化不全骨钙素(ucO C)在老年2型糖尿病患者认知功能评估中的意义。方法招募117例老年2型糖尿病患者,依据简易精神状态量表(MMSE)得分分为认知正常组和认知障碍组,比较两组年龄、糖尿病病程、血糖、血脂和ucO C水平差异,并使用Logistic回归分析评估老年2型糖尿病患者发生认知功能障碍的危险因素。结果与认知正常组相比,认知障碍组年龄偏大,糖尿病病程偏长,糖化血红蛋白(HbA 1c)水平较高,血清unO C水平明显降低,差异均有统计学意义(P0. 01或P0. 05)。Logistic回归分析显示,年龄、糖尿病病程和HbA 1c是老年2型糖尿病患者发生认知功能减退的危险因素,ucO C是保护因素。结论血清unO C水平降低可能是老年2型糖尿病患者发生认知功能障碍的危险因素。     

老年非瓣膜性心房颤动患者轻度认知功能障碍的罹患情况及影响因素

目的 探讨老年非瓣膜性房颤与轻度认知功能障碍(MCI)的关系及相关影响因素。方法 回顾性分析2018年10月至2019年9月于华中科技大学同济医学院附属同济医院综合医疗科住院且符合要求的104例老年患者的临床资料,其中房颤组和非房颤组各52例。应用简易精神状态评价量表(MMSE)与蒙特利尔认知评估量表(MoCA)评估2组患者MCI的检出率、临床特点及危险因素。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ2检验进行组间比较。多因素分析采用logistic回归模型。结果 房颤组患者的MMSE总分和MoCA总分均低于非房颤组[MMSE:(27.37±1.53) 和 (28.33±1.01) 分;MoCA:(24.71±1.54) 和(26.29±1.63)分];MCI检出率明显高于非房颤组(MMSE:38.5%和7.7%;MoCA:61.5%和30.8%),差异均有统计学意义(P＜0.05)。利用MoCA量表评估7个分认知域,显示房颤组患者的定向能力、视空间与执行功能、语言能力、抽象概括能力均低于非房颤组,差异有统计学意义(P＜0.05)。以MoCA量表阳性定义为MCI患者,选取对MMSE量表和MoCA量表评估MCI均有影响的5个因素作为自变量代入logistic回归分析,结果显示较高的受教育年限是MCI的保护因素,而房颤、高龄、高血压是MCI的独立危险因素,其中房颤是更强的危险因素(OR=3.163,95%CI 1.190～8.406;P＜0.05)。结论 老年非瓣膜性房颤患者MCI检出率显著增高,其认知功能障碍主要表现在定向能力、视空间与执行功能、语言能力和抽象概括能力等方面。房颤、年龄、高血压对MCI有影响,通过有效管理房颤等危险因素,可以对MCI的防治起到积极作用。     

住院老年2型糖尿病患者认知功能障碍的特点及其危险因素调查分析

目的调查住院老年T2DM患者认知功能障碍的特点及罹患情况,并分析相关危险因素。方法采用简明智能精神状态检查(MMSE)对118例住院老年T2DM患者进行认知功能评估,分析认知功能障碍的特点及相关危险因素。结果 118例住院老年T2DM患者平均MMSE(21.5±8.6)分。回忆力(94.9%)及近期记忆力(80.5%)受损最常见。认知功能障碍56例(47.5%),其中,痴呆31例(6.3%)。与单纯T2DM组比较,认知功能障碍组年龄更大[(79.0±10.4)vs(71.0±9.6)岁,P=0.045]、糖尿病病程更长[(12.4±9.6)vs(9.2±7.6)年,P=0.038]。Logistic回归分析显示,年龄、T2DM病程是认知功能障碍的影响因素。结论我院老年住院T2DM患者认知功能障碍罹患率高(47.5%),回忆力和近期记忆力最常受损。认知功能障碍的发生可能与年龄、T2DM病程有关。     

Atrial Fibrillation and Cognitive Function: JACC Review Topic of the Week

Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. The assumed multifactorial mechanisms include ischemic stroke, both apparent and silent, cerebral microinfarcts, cerebral hemorrhage, and reduced cerebral blood flow. A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.     

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications

Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients.     

心房颤动对认知障碍影响机制的研究进展

心房颤动（房颤）和认知障碍的发生有密切关系,流行病学研究显示房颤患者明显增加了1.5-2.5倍的认知障碍风险。临床研究提示房颤,特别是持续性房颤对脑组织造成病理生理影响,出现认知功能障碍的表现;房颤患者的抗凝、频率控制和复律等治疗能够减轻发生认知功能障碍的风险。本文对两者关系的最新研究进展进行综述。     

心房颤动导管消融术后复发的危险因素分析

心房颤动是最常见的心律失常之一。导管消融已经成为心房颤动的有效治疗手段,具有较高的手术成功率,特别是阵发性心房颤动,术后成功率更高。然而,导管消融术后复发仍不少见,特别是慢性心房颤动。影响心房颤动经导管消融术后复发的危险因素是多方面的,包括体重、年龄、心房颤动持续时间、炎症、心房纤维化、左房疤痕、左房大小等,识别这些危险因素对指导个体化治疗及提高导管消融的成功率有一定的意义。因此,现对这些危险因素与心房颤动导管消融术后复发的关系做一综述。     

Pharmacological Approach for the Prevention of Atrial Fibrillation After Cardiovascular Surgery

Atrial fibrillation (AF) is a common complication of cardiovascular surgery. The two most important risk factors for its development are advancing age and a preoperative history of AF. Long-term sequelae, such as a stroke, are uncommon, however, atrial fibrillation frequently results in increased length and cost of hospitalization. Strategies to prevent postoperative AF include perioperative beta-blockers, amiodarone, and atrial pacing. These strategies are most effective in high-risk patients. When AF does occur, treatment includes control of the ventricular rate, systemic anticoagulation, and conversion to sinus rhythm.     

Atrial fibrillation and its relation to cardiac diseases and sudden cardiac death

Atrial fibrillation (AF) is the most common arrhythmia in adults. Many studies have reported an association between atrial fibrillation and other cardiac diseases including sudden cardiac death (SCD). According to the literature, the prevalence and incidence of atrial fibrillation have been increasing and AF is associated with higher mortality and morbidity. An increased incidence of AF has been described in patients with ischemic heart disease, heart failure, and arterial hypertension. These conditions share some pathophysiological mechanisms with atrial fibrillation, which is, reciprocally, one of their risk factors. As a result, mortality is 2–4-fold higher in individuals with AF. Increased mortality from, and a higher incidence of, ventricular arrhythmias, including ventricular fibrillation (VF), have been found in patients with implantable cardiac defibrillators (ICD), as well as in the general population where AF has been independently related to an up to 3-fold increased risk of cardiac arrest due to VF. The mechanism of action is based on a direct proarrhythmogenic effect of atrial fibrillation, increased cardiac workload, tachycardia-induced ischemia, or heart failure. Risk stratification, optimization of therapy, and screening for subclinical structural heart disease play an important role in the care of patients with atrial fibrillation.     

Atrial fibrillation,cognition and dementia: A review

Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia, particularly among older adults. AF confers a 5‐fold risk for thromboembolic stroke as well as a 2‐fold higher risk for congestive heart failure, morbidity, and mortality. Although stroke remains an important and impactful complication of AF, recent studies have shown that AF is independently associated with other neurological disorders, including cognitive impairment and dementia, even after adjusting for prior ischemic stroke. We performed a review of the published literature on the association between AF and cognitive status. Further, we reviewed studies investigating the underlying mechanisms for this association and/or reporting the impact of AF treatment on cognitive function. While most published studies demonstrate associations between AF and impaired cognition, no AF treatment has yet been associated with a reduced incidence of cognitive decline or dementia.     

Atrial Fibrillation and Hypertension: Mechanistic,Epidemiologic, and Treatment Parallels

Atrial fibrillation (AF) is an increasingly prevalent condition and the most common sustained arrhythmia encountered in ambulatory and hospital practice. Several clinical risk factors for AF include age, sex, valvular heart disease, obesity, sleep apnea, heart failure, and hypertension (HTN). Of all the risk factors, HTN is the most commonly encountered condition in patients with incident AF. Hypertension is associated with a 1.8-fold increase in the risk of developing new-onset AF and a 1.5-fold increase in the risk of progression to permanent AF. Hypertension predisposes to cardiac structural changes that influence the development of AF such as atrial remodeling. The renin angiotensin aldosterone system has been demonstrated to be a common mechanistic link in the pathogenesis of HTN and AF. Importantly, HTN is one of the few modifiable AF risk factors, and guideline-directed management of HTN may reduce the incidence of AF.     

Arterial hypertension and atrial fibrillation: Selecting antihypertensive therapy

Arterial hypertension is the most common cardiovascular disease. Atrial fibrillation in hypertension has frequent occurrence, which increases with age. While the mechanism underlying the development of atrial fibrillation is complex, hypertension is considered one of the main pathogenic factors resulting in this arrhythmia. Hypertension is also the key risk factor for stroke, with the risk markedly increasing in the presence of atrial fibrillation. In addition, hypertension is a major factor when stratifying the risk of thromboembolism in atrial fibrillation.Antihypertensive therapy reduces not only the risk for stroke but also the risk for atrial fibrillation.Based on current evidence (mostly retrospective data), some classes of antihypertensive agents seem to be more effective than others in preventing recent-onset atrial fibrillation. This paper discusses various options of antihypertensive strategy in hypertensive patients with atrial fibrillation. Anticoagulation and antiarrhythmic therapy make an integral part of AF management.     

心房颤动射频消融复发的临床研究进展

心房颤动(AF)是世界范围内最常见的心律失常,与住院密切相关,其发病率逐年增长,AF相关的医疗保健系统的经济负担也在日益增加。AF射频消融(AFRA)后医疗费用大幅减少。近年来,成为代替药物治疗心房颤动的一种有效的治疗方法。虽然射频消融彻底改变了房颤的处理,但其复发率却是一个很大的缺点。成功的识别影响复发的危险因素对于消除房颤是至关重要的,然而复发频繁发生的原因到目前为止还没有被阐明。本文将从影响房颤射频消融复发的临床因素展开综述,以期识别影响射频消融术后房颤复发的危险因素,从而可以帮助医生更好地选择成功率更高的患者。