非致残性缺血性脑血管事件患者早期淡漠与情感认知障碍的相关性研究

目的 探究非致残性缺血性脑血管事件（NICE）患者早期淡漠与情感认知障碍的关系。方法 收集2021年6月至2022年12月在上海长海医院收治的NICE患者244例，其中男性156例，女性88例，平均年龄为63.1±9.7岁。根据入院时淡漠评估量表-临床医师版（AES-C）评分分为情感淡漠（≥33分，n=64） 组和非淡漠（＜33分，n=180）组。收集患者的人口学资料、血检验结果以及影像学资料，于发病2周内完善匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知评估量表（MoCA）、听觉语词学习测验（AVLT）、数字广度实验（DST）、数字符号转换测验（DSST）、数字连线测验（TMT）、汉密尔顿焦虑、抑郁量表（HAMD、HAMA）等评估。利用t检验或非参数检验比较两组之间资料的差异，多因素Logistic回归分析影响淡漠的因素。结果 NICE后早期淡漠的发生率为26.2%，与非淡漠组相比，淡漠组患者的年龄较高而 BMI和受教育年限较低（所有P<0.05）；两组患者的性别、吸烟、饮酒以及高血压病史无显著性差异（所有P>0.05）。入院时首次血检验结果提示两组患者甲状腺激素水平均无显著性差异（P>0.05），同时TOAST病因分型未发现两组患者的病因存在差异（P>0.05）。使用Fazekas白质评分对白质损伤进行量化结果提示，淡漠组患者的脑白质损伤明显高于非淡漠组（P=0.004）。认知功能检测结果提示，与非淡漠组相比，淡漠组患者认知障碍发生率（MoCA＜26）明显更高（46% vs 59%, P＜0.05）。淡漠组患者的言语流畅性抽象能力、延迟回忆和定向能力均明显减退（所有P<0.05）,两组之间视空间、执行功能以及命名能力无显著差异（所有P>0.05）。此外，淡漠组PSQI、HAMA、HAMD得分均高于非淡漠组,且睡眠障碍、焦虑和抑郁的发生率显著增加（P<0.05）。Logistic回归分析发现HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素（P<0.05）。结论 早期淡漠的NICE患者认知功能障碍发生率更高，且更易出现睡眠障碍以及焦虑和抑郁状态。HAMD得分、年龄以及TMT-A用时为卒中后淡漠的危险因素。

Early Apathy and Emotional Cognitive Impairment in Non-Disabling Ischemic Stroke Patients: A Correlational Study

Objective This study aims to investigate the association between affective cognitive impairment and early apathy in patients with non-disabling ischemic cerebrovascular events (NICE). Methods A total of 244 NICE patients were admitted to Shanghai Changhai Hospital from June 2021 to December 2022, comprising 156 males and 88 females, with a mean age of 63.1±9.7 years. Based on the Apathy Evaluation Scale-Clinician Version (AES-C) scores at admission, patients were categorized into the apathy group (≥33 points, n=64) and the non-apathy group (<33 points, n=180). Demographic data, blood test results and imaging data were collected. Within 2 weeks of symptom onset, assessments including the Pittsburgh Sleep Quality Index (PSQI), Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Digit Span Test (DST), Digit Symbol Substitution Test (DDST), Trail Making Test (TMT), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were conducted. Differences between the two groups were analyzed using t-tests or non-parametric tests, and multiple logistic regression was performed to identify factors influencing apathy. Results The incidence of apathy following NICE was 26.2%. Patients in the apathy group exhibited higher age and lower BMI and education levels compared to those in the non-apathy group (all P<0.05). There were no significant differences in gender, smoking, alcohol consumption, and history of hypertension between the two groups (all P>0.05). The results of the first blood test on admission indicated that there was no significant difference in thyroid hormone levels between the two groups (P>0.05), and no difference in the etiology between the two groups was found in the TOAST etiology classification(P>0.05). The results of quantification of white matter injury by Fazekas score showed that the white matter injury in the apathy group was significantly higher than that in the non-apathy group (P=0.004). The cognitive function test results indicated that the apathy group had a significantly higher prevalence of cognitive impairment (MoCA < 26) than the non-apathy group (46% vs. 59%, P<0.05). Apathy group patients exhibited significant declines in abstract ability, delayed recall, and orientation, as well as reduced verbal fluency (all P<0.05), while no significant differences were found in visual-spatial skills, executive function, and naming ability between the two groups (all P>0.05). Furthermore, the apathy group demonstrated higher PSQI, HAMA, and HAMD scores compared to the non-apathy group, accompanied by a significantly increased incidence of sleep disorders, anxiety, and depression (P<0.05). Logistic regression analysis revealed that HAMD score, age, and the completion time of TMT-A were identified as risk factors for post-stroke apathy (P<0.05). Conclusion Patients with apathy had higher rates of cognitive impairment and were more susceptible to sleep disorders, anxiety, and depression. HAMD score, age, and the completion time of TMT-A were identified as risk factors for post-stroke apathy.