急性缺血性脑卒中后认知障碍患者精神行为症状的特征性分析

目的探讨急性缺血性脑卒中后认知障碍(PSCI)患者精神行为症状(BPS)发生的特征。方法纳入2018年1月~2019年5月苏北人民医院神经内科住院的急性脑梗死患者105例,PSCI患者73例分为脑卒中后痴呆(PSD)组28例和脑卒中后认知障碍非痴呆(PSCI-ND)组45例,脑卒中后非认知障碍(非PSCI)组32例。PSCI患者又分为BPS组50例和非BPS组23例。根据英国牛津郡社区脑卒中规划分型,将急性脑梗死患者分为部分前循环梗死型(PACI)、后循环梗死型和腔隙性脑梗死型(LACI)。认知功能评估采用简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA),BPS评估采用神经精神问卷(NPI)。评价患者日常生活活动能力量表(ADL),并收集相关临床资料。结果PSD组和PSCI-ND组NIHSS评分、NPI总分、BPS发生率均明显高于非PSCI组,教育年限明显低于非PSCI组(P<0.05)。PSD组年龄明显高于PSCI-ND组(P<0.05)。BPS组ADL总分、MMSE总分和MoCA总分明显低于非BPS组(86.90±10.50)分vs(92.61±10.10)分,P=0.032;(24.39±2.13)分vs(20.36±4.27)分,P=0.000;(17.04±4.23)分vs(22.00±2.65)分,P=0.000]。与非BPS组比较,BPS组PACI发生率明显升高(52.0%vs 4.3%,P=0.000),LACI发生率明显降低(20.0%vs 56.5%,P=0.002)。PSD组和PSCI-ND组幻觉、激越、抑郁、淡漠、异常运动和睡眠行为障碍比例明显高于非PSCI组(P<0.05)。PSD组激越、抑郁、淡漠和睡眠行为障碍比例明显高于PSCI-ND组(P<0.05)。结论PSCI患者较易出现BPS,其认知水平不同BPS发生率及表现不同,揭示了PSCI的临床异质性特点,为PSCI的治疗提供临床依据。

Characteristics of behavioral and psycological symptoms of cognitive impairment patients following acute ischemic stroke

Objective To study the characteristics of behavioral and psychological symptoms(BPS)of cognitive impairment patients following AIS.Methods One hundred and five AIS patients admitted to Northern Jiangsu People′s Hospital were divided into post-stroke dementia(PSD)group(n=28),PSD-free group(n=45)and post-stroke cognitive impairment(PSCI)-free group(n=32).The 73 PSCI patients were divided into BPS group(n=50)and BPS-free group(n=23).The 105 AIS patients were divided into partial anterior circulation infarction(PACI)group,posterior circulation infarction group and lacunar infarction(LACI)group according to the Oxford Shire Community Stroke Project.The cognitive function of the patients was assessed according to their MMSE scale score and MoCA scale score.The BPS were assessed according to their neuropsychiatric inventory(NPI)score.Their ADL was assessed and their clinical data were recorded.ResultsThe score of NIHSS,NPI and the incidence of BPS were significantly higher while the educational time was significantly shorter and the age was significantly older in PSD group and PSD-free group than in PSCI-free group(P<0.05).The total score of the ADL scale and MMSE scale and MoCA scale were significantly lower in BPS group than in BPS-free group(86.90±10.50 vs 92.61±10.10,P=0.032;24.39±2.13 vs 20.36±4.27,P=0.000;17.04±4.23 vs 22.00±2.65,P=0.000).The incidence of PACI was significantly higher while that of LACI was significantly lower in BPS group than in BPS-free group(52.0%vs 4.3%,P=0.000;20.0%vs 56.5%,P=0.002).The incidence of hallucination,agitation,depression,indifference,abnormal movement and sleep behavior disorder was significantly higher in PSD group and PSD-free group than in PSCI-free group(P<0.05).The incidence of agitation,depresssion,apathy and sleep behavior disorder was significantly higher in PSD group than in PSD-free group(P<0.05).Conclusion BPS are common and the incidence of BPS varies with the cognitive function in PSCI patients.BPS can show the clinical heterogeneity of PSCI and provide the clinical basis for its treatment.