脑梗死存活率影响因素的前瞻性研究

目的研究脑梗死后痴呆对存活率的影响。方法对619例急性脑梗死患者进行人文因素、血管因素、卒中特征资料收集和神经心理检查。在入院及卒中后3个月按美国精神病学会DSM-Ⅳ标准对卒中患者进行痴呆诊断,随访2年,分析痴呆患者的存活率及死亡相关预测因素。结果 卒中后3个月共有146例(23.6％)患者被诊断为痴呆,其中39例为卒中前痴呆,107例为卒中相关痴呆。随访(19.4±8.3)个月,卒中后痴呆患者存活率为49.3％,随访(21.3±9.1)个月,卒中相关性痴呆存活率为53.7％,非痴呆患者存活率为92.0％。多因素分析显示,卒中后痴呆与死亡明显相关,脑梗死后痴呆病死率的独立危险因素是年龄、心房颤动、卒中史、日常生活能力评分、卒中后痴呆和卒中相关痴呆。结论痴呆降低卒中患者存活率,并可作为卒中后存活的一个预测因素。     

脑卒中后癫痫的临床分析

目的分析脑卒中与卒中后癫痫的相关危险因素。方法通过对80例脑卒中患者2年追踪观察，分析癫痫与脑卒中的年龄、性别、卒中的部位、病变的大小、脑卒中的类型的关系。结果脑卒中病变累及大脑皮层，大面积卒中更容易发生卒中后癫痫。结论卒中后癫痫发生易患因素依次为卒中的部位、卒中病灶的大小。     

广西重阳老年公寓老年人脑卒中后抑郁状况及影响因素分析

目的 调查居住在广西重阳老年公寓的老年人脑卒中后抑郁症状发生率及其影响因素,为改善老人的心理卫生状况,促进老年公寓服务的改进与完善提供科学依据.方法 对居住在广西重阳老年公寓的老年脑卒中患者进行整群随机抽样.以日常生活能力量表(ADL)、老年抑郁量表(GDS)为筛查工具,确诊入选病例.调查抽样人群的卒中后抑郁的发生率,同时对基本信息和老年人常见疾病情况进行调查.结果 本组脑卒中后抑郁发生率为85.4%(76/89),多因素Logistic逐步回归筛选出影响脑卒中后抑郁症状加重的因素是日常生活能力下降、老年公寓居住的满意度.结论 广西重阳老年公寓的老年人脑卒中后抑郁症状发生率较高,应重视和加强对居住在老年公寓脑卒中患者的预防和康复干预.     

缺血性脑卒中后痴呆的发生率及临床决定因素

目的探讨缺血性脑卒中后痴呆的发生率及临床决定因素。方法选择缺血性脑卒中患者386例进行前瞻性研究,于脑卒中后7～10 d进行初次神经心理学评估,脑卒中后3个月再次对资料完整的309例患者进行全面神经心理评估及Hamilton抑郁等级量表分级,并根据309例患者是否合并痴呆分为痴呆组65例和非痴呆组244例,对缺血性脑卒中后痴呆的相关因素进行分析。结果缺血性脑卒中后痴呆发生率为21.04%。与非痴呆组比较,痴呆组年龄更高、体力劳动者更多、糖尿病、既往脑卒中史、颈内动脉中、重度狭窄和脑白质疏松症患者的比例更高(P0.05)。痴呆与年龄、职业、糖尿病、既往脑卒中史、颈内动脉中、重度狭窄、脑白质疏松症及脑卒中部位和严重程度显著相关。职业、颈内动脉中、重度狭窄和脑白质疏松症是缺血性脑卒中后痴呆的临床决定因素。结论缺血性脑卒中后痴呆的发生率高,职业、颈内动脉中、重度狭窄和脑白质疏松症可作为缺血性脑卒中后痴呆的预测因素,及早诊断,积极治疗脑卒中后痴呆意义重大。     

老年人脑卒中后难治性癫痫的危险因素分析

目的探讨老年人脑卒中后继发难治性癫痫（ＩＥＰ）的危险因素。方法脑卒中后ＩＥＰ组５６例，可控性癫痫组１７９例，单纯脑卒中组１４４７例。三组均系同期住院的脑卒中患者。对研究资料先进行单因素分析，然后进行多因素非条件Ｌｏｇｉｓｔｉｃ回归模型分析。结果经分析筛选出皮质损害、单纯部分性运动性发作、癫痫家族史、脑电图背景活动异常、迟发性癫痫等５个因素为ＩＥＰ的危险因素，大面积脑出血或梗塞、蛛网膜下腔出血、电解质紊乱、皮质损害等４个因素为可控性癫痫的危险因素。结论脑卒中后ＩＥＰ的发生在很大程度上决定于脑损伤部位，与遗传因素也有关联，而可控性癫痫的发生主要与脑组织坏死灶大小关系密切。     

老年脑梗死后痴呆危险因素的临床研究

目的探讨老年脑梗死后痴呆的临床危险因素。方法选择于2002年10月~2004年10月入住天津港口医院的脑梗死患者共362例,其年龄≥60岁,男性192例,女性170例,包括其住院时及发病后2个月的病史、化验结果、神经病学、神经心理学等方面的临床资料,并进行统计学分析。结果入选362例患者中诊断为痴呆者102例(发生率为28.2%)。logistic回归分析显示高龄、低教育、脑卒中史、糖尿病、严重神经功能缺损、左半球脑梗死、前循环脑梗死等因素为脑梗死后痴呆的独立危险因素。结论老年脑梗死后约有1/4患者出现痴呆,其临床危险因素包括:梗死部位及严重程度、血管性危险因素(如糖尿病、脑卒中史)、患者的特征(如高龄、文化程度低)等。     

老年脑卒中后抑郁障碍的临床对比分析

目的 评价老年脑卒中患者抑郁障碍的发病率、病变部位、神经功能缺陷程度、病程及相关危险因素。方法 应用老年抑郁自评量表(SD)对老年脑卒中及中年脑卒中两组病人进行抑郁评估及加拿大神经功能缺陷量表(CNS)对两组病人进行神经功能缺陷评估，并通过脑CT、MRI及危险因素合并情况对两组病人的病变部位与抑郁发生相关性进行对比。结果 老年脑卒中抑郁障碍的发病率为58.82％明显高于中年人(41．55％)，老年女性更高(68．57％)。额叶、颞叶、基底节病变及多发性脑梗死抑郁发病率明显增高，与神经功能缺陷程度及恢复的时间相关，相关危险因素多抑郁发生率高。结论 老年脑卒中后抑郁障碍与病变部位、神经功能缺陷程度、病程、相关危险因素密切相关。     

海南省老年糖尿病合并脑卒中的临床危险因素

目的探讨海南省老年2型糖尿病合并脑卒中的临床特点,并对其相关的危险因素进行分析。方法回顾性对海南省180例老年2型糖尿病合并脑卒中组、非糖尿病脑卒中组及糖尿病无卒中组的临床病历资料(患者的基本资料、体重指数、血压、血糖、糖化血红蛋白、空腹胰岛素、脂质代谢水平和临床表现等)进行分析比较。结果老年2型糖尿病并脑卒中患者中高血压的发生率(67%)高于非糖尿病脑卒中组及糖尿病无卒中组(P0.05)。老年糖尿病合并脑卒中组以缺血性脑梗死多见(83%),更容易出现肢体偏瘫(P0.01)和失语(P0.05)。血脂、血糖、尿酸、纤维蛋白原的水平高于糖尿病无卒中组和非糖尿病脑卒中组(P0.05)。采用Logistic逐步回归分析显示,体重指数、低密度脂蛋白胆固醇、收缩压和餐后血糖水平与脑梗死显著相关(OR分别为0.59、2.29、0.78、2.31和0.06)。结论老年糖尿病合并脑卒中时有特征性临床表现模式,血糖控制不佳,高血压、高血脂、高尿酸、高纤维蛋白原是老年2型糖尿病并发脑卒中主要危险因素,影响预后。     

老年无卒中房颤病人的痴呆发病风险及其危险因素分析

目的 探讨老年无卒中房颤病人的痴呆发病风险及其危险因素.方法 纳入2014年7月至2017年2月我院收治的113例无卒中房颤病人,按照随访其是否发生痴呆分为痴呆组和对照组.分析2组病人的临床资料、用药情况,采用多因素Logistic回归分析影响无卒中房颤病人发生痴呆的危险因素.结果 113例病人的中位随访时间为41(2...     

青年缺血性脑卒中病因及相关危险因素的分析研究

目的探讨青年缺血性脑卒中的常见病因及危险因素。方法回顾性分析51例18～45岁青年脑卒中患者病例资料,并与74例45岁以上老年脑卒中患者进行对照研究,探讨青年患者发病的病因及危险因素。结果青年组非动脉粥样硬化性血管病变及无明显血管病变的比例高于老年组,常见危险因素包括血脂异常(尤其总胆固醇、三酰甘油及脂蛋白-A)、高血压及吸烟。空腹血糖、低密度脂蛋白和纤维蛋白原等指标与老年脑卒中有关。结论青年脑卒中病因及危险因素多样,且有特殊性,不明原因的病例占较大比例,明确病因有赖于完善各项检查。     

非痴呆型血管认知功能障碍危险因素分析

目的探讨慢性脑供血不足(CCCI)致非痴呆型血管认知功能障碍的危险因素。方法将120例CCCI患者根据临床痴呆评定量表(CDR)分为非痴呆性血管性认知功能障碍组(VCIND组,52例)及非VCIND组(68例),建立logistic回归模型,分析CCCI患者高血压、糖尿病、高脂血症、脑梗死等各种危险因素与VCIND的关系。结果单因素分析结果显示糖尿病、脑梗死的多次发作及多部位发生及低教育程度与CCCI致VCIND有关;多因素分析证实糖尿病、脑梗死的多次发作及多部位发生及低教育程度与CCCI致VCIND有关,OR值分别为13.255、12.862、9.051、1.486(P0.01)。结论糖尿病、脑梗死的多次发作及多部位发生、低教育程度与CCCI致VCIND有关,可能是CCCI致VCIND的独立危险因素。     

Neuroimaging predictors of dementia in stroke patients

The risk of dementia is increased in stroke patients. Dementia syndromes associated with cerebrovascular diseases were commonly recognized as an immediate consequence of stroke. However, more and more data suggest that degenerative pathology and white matter changes (WMC) may play a role in the development of dementia in stroke patients. The aim of this paper was to review the literature concerning the neuroimaging predictors of dementia in stroke patients. From the literature data, it appears that although vascular lesions alone may lead to dementia, in stroke patients, no clear association between stroke location and size has yet been identified, even if the role of the left hemisphere has been suggested. The influence of silent infarcts remains undetermined while more and more data suggest that global cerebral atrophy and WMC are predictive factors of post-stroke dementia (PSD). The influence of medial temporal lobe atrophy on the risk of PSD has until now never been evaluated.     

NEUROIMAGING PREDICTORS OF DEMENTIAIN STROKE PATIENTS

The risk of dementia is increased in stroke patients. Dementia syndromes associated with cerebrovascular diseases were commonly recognized as an immediate consequence of stroke. However, more and more data suggest that degenerative pathology and white matter changes (WMC) may play a role in the development of dementia in stroke patients. The aim of this paper was to review the literature concerning the neuroimaging predictors of dementia in stroke patients. From the literature data, it appears that although vascular lesions alone may lead to dementia, in stroke patients, no clear association between stroke location and size has yet been identified, even if the role of the left hemisphere has been suggested. The influence of silent infarcts remains undetermined while more and more data suggest that global cerebral atrophy and WMC are predictive factors of post-stroke dementia (PSD). The influence of medial temporal lobe atrophy on the risk of PSD has until now never been evaluated.     

糖尿病合并高血压脑卒中患者血管紧张素转换酶基因多态性的观察

目的研究血管紧张素转换酶（ＡＣＥ）基因的插入多态性与糖尿病合并高血压脑卒中发病的关系。方法应用ＰＣＲ扩增方法鉴定５０例糖尿病并高血压脑卒中患者、６９例糖尿病无血管病变患者和８５例健康对照者的ＡＣＥ基因多态性。结果糖尿病并高血压脑卒中患者ＡＣＥ基因的插入／插入纯合型频率（４６％）明显高于对照组（３０％）（＜Ｐ０．０５）；插入／缺失杂合型及缺失／缺失纯合型的频率（分别为２８％和４８％）与对照组（分别为２６％和２２％）差异无显著性（均为Ｐ＞０．０５）。糖尿病无血管并发症患者ＡＣＥ基因各型与对照组差异无显著性（均为Ｐ＞０．０５）。脑ＣＴ扫描显示基因插入／插入纯合型的糖尿病并高血压脑卒中患者中，７６％有多发腔隙性脑梗塞。结论ＡＣＥ基因插入／插入纯合型与脑卒中发病相关。     

脑卒中后吞咽障碍多因素分析及对预后的影响

目的:探讨急性脑卒中患者吞咽障碍的发生因素及对并发肺部感染和卒中患者预后的影响。方法:432例意识清醒,无明显认知功能障碍及听理解障碍的急性脑卒中患者,均经头颅CT和(或)MRI检查证实,并明确卒中的部位、类型、病灶大小及数目,入院时及3～4周对患者神经功能缺损及生活活动能力进行评分。根据吞咽障碍的临床诊断标准分为吞咽正常组及吞咽障碍组,对吞咽障碍组的患者进行洼田饮水试验评估吞咽障碍的程度,根据结果将吞咽障碍程度分为轻、中、重度三个亚组。结果:432例脑卒中患者中,246例有不同程度的吞咽障碍(56.9%)。其中122例脑出血患者中,70例有吞咽障碍(57.4%),310例脑梗死患者中,176例有吞咽障碍(56.8%),二组比较无显著性的差异;吞咽正常患者与吞咽障碍各亚组患者在年龄、性别、病史以及卒中类型的比较无显著性差异,但中、重度吞咽障碍亚组既往有卒中史的患者比例高于吞咽正常组及轻度吞咽障碍组(P<0.05);脑干卒中、大病灶、双侧半球病灶及多发病灶的卒中患者吞咽障碍的发生率明显增高且严重,中度和重度吞咽障碍的脑卒中患者入院时神经功能缺损严重、并发肺部感染显著多于轻度和无吞咽障碍的患者,中度和重度吞咽障碍的脑卒中患者治疗3～4周神经功能缺损评分及Barthel指数无明显的改善,预后不良;Logistic回归分析发现:脑干卒中、大病灶、多发病灶、入院时NIHSS分值高及BI分值低是脑卒中患者发生吞咽障碍的危险因素。结论:脑卒中后吞咽障碍及其严重程度与卒中部位、病变大小、多少及卒中的严重程度有关,脑干卒中和病灶大的卒中患者常合并重度吞咽障碍和并发肺部感染,中、重度吞咽障碍的卒中患者预后差。     

血管性痴呆危险因素的研究

目的研究脑梗死后痴呆的危险因素。方法本研究纳入546例脑梗死急性期住院患者,完成随访434例,于住院期间和脑卒中3个月后进行神经心理测试,其中痴呆组118例,非痴呆组316例。运用t检验、χ2检验和logistic回归法分析血管性痴呆的发生率和危险因素。结果本研究中血管性痴呆的发生率为27.2%。单因素分析表明,血管性痴呆组的年龄比非痴呆组高8.5岁,在低教育水平(小学以下)、每日饮酒、脑卒中史等方面的比例显著高于非痴呆组。logistic回归分析表明,年龄、低教育水平、每日饮酒和脑卒中史与血管性痴呆相关。结论血管性痴呆是血管因素和退行性因素共同作用的结果,其中血管因素在血管性痴呆发病机制中起主导作用。年龄、低教育水平、每日饮酒和脑卒中史是血管性痴呆的危险因素。     

Clinical significance of cerebral white matter lesions in older Asians with suspected dementia

BACKGROUND: cerebral white matter lesions are commonly seen on neuroimaging in older people and have been associated with clinical features such as gait abnormalities, urinary incontinence and depression. The significance of cerebral white matter lesions in older people with dementia remains uncertain. OBJECTIVES: to study the association between cerebral white matter lesions and the presence or absence of dementia in a group of elderly Asian patients; and to determine the clinical significance of cerebral white matter lesions in patients who are diagnosed to have dementia in terms of associated clinical features and the impact of cerebral white matter lesions on cognitive status. METHODS: for the first objective, the records of 141 older people of Asian ethnicity presenting to a memory clinic for the evaluation of suspected dementia were reviewed to compare the prevalence of cerebral white matter lesions in patients who did not fulfil the criteria for dementia, patients diagnosed to have Alzheimer's disease and patients diagnosed to have vascular dementia. For the second objective, 115 of these patients who were diagnosed to have dementia were studied to determine if demented patients with cerebral white matter lesions were more likely to have urinary incontinence, Parkinsonism, depression and greater severity of dementia. In addition, a comparison was made between demented patients with cerebral white matter lesions and those without cerebral white matter lesions in terms of psychometric assessment scores. RESULTS: cerebral white matter lesions were more common in Asian patients with vascular dementia. Demented patients with cerebral white matter lesions were also found to have more severe dementia and greater functional disability. CONCLUSION: cerebral white matter lesions are common, and are associated with greater functional disability in elderly Asian patients with dementia.     

INOBVIOUS STROKE: A CAUSE OF DELIRIUM AND DEMENTIA

Six hundred and sixty-one patients with stroke, confirmed by CT scan or at autopsy, were reviewed in order to evaluate the frequency of presentation with altered mental state. Nineteen patients (3%) had presented with delirium, an organic delusional state, the acute onset of dementia, or mania, mimicking psychiatric illness. All had focal cerebrovascular lesions which were usually, but not invariably, right sided. None had a previous history of cognitive impairment, psychiatric disease, drug abuse, or alcohol excess. Neurological signs were absent or mild and transient, and therefore easily missed. Post-mortem examinations in four patients showed localised cerebral infarctions with no evidence of multiple lesions, Alzheimer's disease, or metabolic encephalopathies. The possible causative factors are discussed and the evidence of asymmetrical cerebral representation of emotion, and for a relationship with epilepsy, is reviewed.