氧化应激与缺血性卒中

缺血性卒中的发病率、致死率和致残率均很高.越来越多的研究表明,氧化应激是缺血性腩损伤的主要病理生理学机制之一.文章对氧化应激的病理生理学机制以及缺血性卒中抗氧化治疗的研究进展做了综述.     

卒中后抑郁的危险因素和机制

抑郁症是卒中后常见的一种并发症,常与残疾、认知障碍和病死率增高相关.文章就卒中后抑郁的流行病学、危险因素、预测因素和病理生理学机制进行了综述.     

缺血性卒中后认知损害的危险因素

对缺血性卒中后认知损害的早期诊断和早期干预,可延缓疾病进展以及预防痴呆的发生.文章对缺血性卒中引起认知损害的各种危险因素的研究进展进行了综述.     

慢性脑缺血导致认知障碍的病理生理学机制

慢性脑缺血足一种常见的病理学状态,早期以认知功能损害为主要表现,最终导致持久或进展性认知障碍和神经功能缺损.慢性肭缺血引起的神经元损伤、突触异常、能量障碍以及中楸胆碱能和单胺能系统功能缺损是其导致认知障碍的病理生理学机制.     

慢性脑缺血导致认知障碍的病理生理学机制

慢性脑缺血足一种常见的病理学状态,早期以认知功能损害为主要表现,最终导致持久或进展性认知障碍和神经功能缺损.慢性肭缺血引起的神经元损伤、突触异常、能量障碍以及中楸胆碱能和单胺能系统功能缺损是其导致认知障碍的病理生理学机制.     

卒中后认知损害的预测因素

卒中后认知损害(post-stroke cognitive impairment, PSCI)是指卒中后发生的认知功能下降,包括轻度认知损害和痴呆。预防PSCI至关重要,寻找预测因素是一个值得探索的方向。文章对PSCI预测因素的研究进展进行综述,包括人口统计学特征、卒中发病时的影像学特征、卒中本身特征以及分子标记物等,...     

进展性卒中相关危险因素的预测价值

进展性卒中的病理生理学机制目前尚不清楚,难以准确预测哪些患者会出现神经功能恶化.卒中早期的血压水平、C-反应蛋白浓度、脑动脉狭窄程度、高血糖和卒中部位等因素与进展性卒中密切相关,对其发生有一定预测价值.     

卒中后焦虑

卒中后焦虑是卒中患者最常见和最重要的并发症之一,可严重影响卒中患者的康复以及日常生活和工作。文章就卒中后焦虑的流行病学、临床特征、危险因素和预测因素、病理生理学机制、预防和治疗进行了综述。     

卒中后癫痫发作和卒中后癫痫

卒中可导致偏瘫、失语和认知损害,还会并发癫痫发作甚至癫痫.近年来,有关卒中后癫痫发作和卒中后癫痫的研究越来越多,但主要集中在危险因素方面.文章对卒中后癫痫发作和卒中后癫痫的危险因素、发病机制和治疗进行了综述.     

卒中后情感淡漠

情感淡漠是卒中后的一种常见神经精神并发症.识别卒中后情感淡漠及其相关因素并对其进行有效干预,有助于卒中患者的康复.文章对卒中后情感淡漠的发病率、病理生理学机制、诊断评估和治疗等进行了综述.     

Cognitive impairment after stroke

Cognitive ability was assessed in a consecutive series of 189 six-month survivors of an acute stroke. Twenty-two patients were cognitively impaired at six months. Amongst 10 patients whose cognitive ability deteriorated between one and six months, four also had marked depressive symptoms. Age and severity of stroke were the factors most strongly associated with cognitive impairment at six months. Patients with left hemisphere damage had significantly more difficulty with short-term recall and those with bilateral hemisphere signs were most at risk of cognitive impairment. Patients with cognitive impairment after a stroke should be carefully assessed for depressed mood which may benefit from treatment.     

缺血性卒中后认知障碍

缺血性卒中可导致不同程度的认知障碍,其发病率很高.认知障碍的早期诊断能提供最佳干预和治疗时机,并延缓疾病进展,因此越来越受到关注.文章对缺血性卒中后认知障碍的病因、发病机制、危险因素、诊断和防治方面的进展做了综述.     

介入血运重建改善颈动脉次全闭塞伴轻卒中患者认知障碍的研究

目的研究颈内动脉次全闭塞伴有轻卒中患者认知障碍的特点,明确介入颈动脉血运重建对这类患者认知障碍的改善作用。 方法续贯纳入济宁市第一人民医院神经内科自2016年2月至2019年2月住院的一侧颈动脉次全闭塞伴有轻卒中患者,住院期间完成介入颈动脉血运重建手术,分别在术前和术后3个月接受MMSE评分和MoCA评分检查。 结果共纳入33例患者,所有患者住院期间成功接受了介入颈动脉血运重建。患者术前33例患者在接受MoCA评分时都提示认知功能下降（19.58±1.54）,而MMSE评分未发现有认知功能下降（26.88±0.74）。33例接受介入颈动脉血运重建患者术后3个月的MMSE和MoCA评分较术前均有提高,而且差异具有统计学意义（P<0.05）。 结论颈内动脉次全闭塞伴有轻卒中患者的认知障碍的特点是MoCA评分较MMSE评分更敏感,能够发现早期认知功能障碍。介入血运重建技术能够改善颈内动脉次全闭塞伴有轻卒中患者的认知功能障碍。     

尼克酰胺腺嘌呤二核苷酸磷酸氧化酶在血管性认知障碍中的作用及其机制的研究进展

氧化应激(OS)是导致血管性认知障碍(VCl)的因素之一.尼克酰胺腺嘌呤二核苷酸磷酸(NADPH)氧化酶(NOX)产生的活性氧(ROS)是VCI重要的致病分子.VCI的危险因素如高血糖及缺血/再灌注等在上游增加NOX的活化;其他危险因素如高龄、高血压及卒中是NOX依赖ROS产生的下游损伤.VCI的成因包括与NOX相关的...     

卒中后认知功能障碍的转归及其影响因素

卒中后认知功能损害是脑卒中常见的并发症,其发病率为21．8％-50．O％。卒中后认知功能损害不仅影响患者的生存质量,也给家庭和社会带来负担。但是在度过急性期后,卒中后发生认知功能损害的患者也出现了不同的转归。年龄比较小、卒中前认知功能状态良好的患者相对容易出现认知功能的好转,但是年龄偏大、卒中前认知状况差、文化程度低、血压控制偏低、脑白质变性程度较重、合并糖尿病的患者即使度过了卒中急性期仍易出现认知功能的进一步恶化。而性别,卒中部位,卒中常见的危险因素,如高血压、高血脂、心脏病病史、饮酒史等,对卒中后认知功能障碍的临床转归产生的影响有待于进一步证实。     

Cognitive dysfunction after acute lacunar infarct

Vascular dementia and vascular cognitive impairment have attracted more attention recently due to their association with increased risk of death and institutionalization. The purpose of the present study was to detect and identify the characteristics of cognitive impairments during the early stage of lacunar stroke. The subjects consisted of 23 consecutive first-ever acute lacunar infarction patients who were admitted to the Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, from November 2001 to October 2002. The National Institutes of Health Stroke Scale and Cognitive Abilities Screening Instrument (CASI) were used to evaluate stroke severity and cognitive function, and assessments were performed by a neurologist and psychologist, within 10 days of stroke onset. Of the 23 patients, 21 (91.3%) had CASI scores below their respective cutoff values and all patients had cognitive impairment in at least one cognitive domain in CASI. There were no significant correlations between CASI abnormality (below the cutoff value) and patient age, education, or the interval from stroke onset. Recent memory impairment was the most often impaired cognitive domain on CASI (19 patients, 82.6%). There were significant correlations between recent memory and "attention or concentration"(correlation coefficient, 0.52; p < 0.05), and "abstraction and judgment" (correlation coefficient, 0.44; p < 0.05). The correlations between recent memory and other domains were not significant. It was concluded that cognitive impairment after acute lacunar infarct is quite common and recent memory is the most often impaired cognitive domain. This may have been caused by the location of the specific lesion as well as by the impairment in "attention or concentration" or "abstraction and judgment".     

卒中后认知功能变化规律及其影响因素分析

目的 研究卒中后认知功能的变化规律及其影响因素.方法 收集西安交通大学医学院第一、第二附属医院和陕西省人民医院住院98例首发卒中患者,简短照料者问卷得分≤56分,卒中发病2周之内,无意识障碍及失语,至少一侧上肢肌力≥3级,能够完成量表测查者,分别于卒中急性期(发病2周以内)、卒中后6、12周,应用简易精神状态量表(MMSE)和蒙特利尔认知功能评定量表(MoCA)评定认知功能.结果 MMSE测定卒中急性期、卒中后6、12周认知功能障碍发生率分别为24.5%、12.1%和9.9%;MoCA测定卒中急性期、卒中后6、12周认知功能障碍发生率分别为86.8%、68.2%和38.0%.Logistic回归分析显示,与卒中后认知功能障碍相关的因素有高龄(B=-0.124)、高血压史(β=-3.705)、低教育程度(β=0.560)和卒中后抑郁(β=4.613)(P＜0.05);而低教育程度(β=0.710)、冠心病史(β=-3.649)、TC水平增高(β=-3.361)、LDL-C水平增高(B=-5.833)和卒中后抑郁(β=-3.612)影响卒中后认知功能恢复(P＜0.05).结论 卒中后12周内认知功能逐渐改善,认知障碍发生率逐渐降低,低教育程度、冠心病史、TC、LDL-C水平增高和卒中后抑郁影响卒中后认知功能恢复.

Abstract：

Objective To investigate the evolution of cognitive function and its influence factors,so as to provide evidence for guiding treatment of cognitive impairment after stroke.Methods A total of 98 cases of patients with stroke admitted in the First and Second Affiliated Hospital of Medical College of Xi'an Jiaotong University and Shaanxi Provincial People's Hospital between April and September 2009 were enrolled and recruited.Mini-mental state examination(MMSE) and Montreal cognitive function rating scale (MoCA) were adopted to assess the evolution of cognition at acute phase( within 2 weeks),6 weeks,and 12 weeks after stroke among patients within 2 weeks after onset,questionnaire score≤56,without aphasia and consiousness disturbance and at least one side of upper extremities muscle force ≥ grade 3.Results When using MMSE scale as criteria,the incidence of cognitive impairment was 24.5% at acute phase,12.1% at 6 weeks and 9.9% at 12 weeks after stroke,while the incidence was 86.8%,68.2%,and 38.0% respectively when using MoCA scale as criteria.The scales of MMSE and MoCA were increased and the incidence of cognitive impairment was decreased within 12 weeks after stroke.Logistic regression analysis indicated that,advanced age( β = -0.124 ),hypertension ( β = -3.705 ),low education level ( β = 0.560 )and depression after stroke ( β =4.613 ) were related with cognitive impairment after stroke ( all P values ＜0.05 ); low education level ( β = 0.710 ),coronary heart disease ( β = -3.649 ),elevated total cholesterol (TC) ( β = -3.361 ) and low density lipid cholesterol (LDL-C) ( β = - 5.833 ),and depression ( β =-3.612) delayed recovery of cognition after stroke.Conclusions The cognitive function improves and the incidence of cognitive impairment lowers as the time goes on within 12 weeks after stroke.The factors that may affect the improvement of cognitive function include low educational level,coronary heart disease,elevated TC and LDL-C,and post-stroke depression.     

Arterial hypertension and cognitive deficit

Cognitive impairment and dementia are more and more common in the elderly. The first begins, it advances silently and it leads to dementia in few years. Arterial hypertension represents the most important cerebrovascular risk factor after age. In numerous studies an inverse relationship between blood pressure values and cognitive performance emerges: it is possible that arterial hypertension plays a role in the pathogenesis of cognitive decline. Even in asymptomatic subjects the magnetic resonance signs of cerebral damage accompany cognitive impairment development. Antihypertensive therapy influence on cognitive function represents a subject of actual interest. The most studied drugs are calcium antagonists and ACE-inhibitors; they seem to have a protective effect on cognitive impairment, with regard to diuretics and beta-blockers. It would be important to study hypertensive patients, above all young asymptomatic hypertensives, even about cognitive functions, to prevent and consider cognitive decline and effective organ damage.     

Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes

OBJECTIVES: To identify factors that were associated with cognitive impairment 3 months after stroke, and to examine the associations of cognitive impairment with stroke outcomes up to 4 years after stroke. DESIGN: Observational study. SETTING: Population-based stroke register. PARTICIPANTS: Six hundred forty-five subjects with first-ever stroke, identified from the register. MEASUREMENTS: Subjects were assessed for cognition using the Mini-Mental State Examination (MMSE) 3 months after stroke. Cognitively impaired subjects (MMSE <24, n = 248 (38%)) were compared with cognitively intact subjects (MMSE 24-30, n = 397) in terms of demographic details, stroke risk factors, laterality of stroke, and initial poststroke impairments. Outcome data collected at 1, 3, and 4 years poststroke included disability assessed by the Barthel Index (BI) and the Frenchay Activity Index, case fatality, and institutionalization. RESULTS: Two hundred forty-eight (38%) of 645 subjects were cognitively impaired 3 months after stroke. Using multivariate analyses, cognitive impairment was associated with age of 75 and older (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.5-4.2), ethnicity (Caribbean/African (OR = 1.9, 95% CI = 1.2-3.2) and Asian (OR = 3.4, 95% CI = 1.1-10.2), lower socioeconomic class (OR = 2.1, 95% CI = 1.3-3.3), left hemispheric lesion (OR = 1.6, 95% CI = 1.01-2.4), visual field defect (OR = 2.0, 95% CI = 1.2-3.2), and urinary incontinence (OR = 4.8, 95% CI = 3.1-7.3). Using multivariate analyses, cognitive impairment was associated with death or disability (BI <15) at 4 years after stroke (OR = 2.2, 95% CI = 1.1-4.5). In univariate analyses, it was also associated with higher institutionalization 4 years after stroke (P =.001). CONCLUSIONS: Cognitive impairment is common 3 months after stroke and is independently associated with older age, ethnicity, lower social class, left hemispheric stroke, visual field defect, and urinary incontinence. It is associated with poor long-term outcomes, including survival and disability, up to 4 years after stroke. Because physical and cognitive impairments after stroke have independent prognostic implications, measures that evaluate both functions should be used in future studies of stroke outcome and in care of stroke patients.     

急性缺血性卒中患者血压变异性与认知损害的相关性

目的：探讨血压变异性与急性缺血性卒中患者卒中后认知损害的相关性。方法纳入急性缺血性卒中住院患者,收集人口统计学和临床资料,计算发病7d内血压变异系数,在发病后3个月时采用蒙特利尔认知评估量表评价认知功能。采用多变量logistic回归分析确定发病7 d内血压变异系数与发病后3个月认知损害的关系。结果共纳入708例急性缺血性卒中患者。3个月随访时,510例（72.0％）存在认知损害,198例（28.0％）认知功能正常。认知损害组收缩期血压变异系数（8.3±1.2对8.7±1.4;t=－3.299,P=0.001）和舒张期血压变异系数（7.8±1.3对8.0±1.5;t=－2.529,P=0.012）均显著高于认知功能正常组。以第1五分位数组为参照,校正其他混杂因素后,多变量logistic回归分析显示,发病后3个月认知功能损害与7 d内收缩压变异系数显著相关,第2~5五分位数的优势比及95％可信区间分别为2.33（1.18~4.60）、2.31（1.15~4.66）、2.70（1.29~5.65）和4.82（1.92~12.1）（P均<0.05）。结论缺血性卒中急性期收缩压变异性与认知损害相关。