缺血性卒中后早期认知功能恶化的相关危险因素

目的：探索缺血性卒中后早期（3个月内）认知功能恶化的发生率以及相关危险因素。方法：前瞻性连续入组住院治疗的195例急性缺血性卒中患者。根据卒中急性期(发病14天以内)和卒中后3个月患者简明精神状态量表（MMSE）总分是否降低2分以上，分为认知功能恶化组和非恶化组，并进行组间对比。采用logistic回归分析缺血性卒中后3个月内认知功能恶化的危险因素。结果：缺血性卒中急性期有117例（60.0%）患者被诊断为卒中后认知障碍（PSCI）。卒中后3个月有37例（19.0%）患者发生了认知功能的恶化。单因素logistic回归分析显示缺血性卒中后3个月内认知功能恶化和年龄、性别、受教育年限、急性期MMSE评分、急性期CDR评分、入院时糖化血红蛋白水平有关( P<0.05) 。多因素logistic回归分析显示，年龄>70岁（RR=2.509，P=0.045）、文盲(RR=3.038，P=0.011)、入院时糖化血红蛋白水平(RR=1.364，P=0.016)是缺血性卒中后3个月内认知功能恶化的危险因素；急性期MMSE评分(RR=0.852，P=0.001)为其保护因素。结论：缺血性卒中早期认知功能恶化的发生率达19.0%。年龄>70岁、文盲、糖化血红蛋白水平高、卒中急性期存在严重的认知功能障碍是缺血性卒中患者早期认知功能恶化的危险因素。

Risk factors for early-stage cognitive deterioration after ischemic stroke

Objective To investigate the incidence and risk factors for cognitive deterioration occurred within the first three months after ischemic stroke. Methods A total of 195 patients with acute ischemic stroke were consecutively enrolled in this prospective study. The patients were divided into two groups: cognitive deterioration and non-cognitive deterioration group, according to whether the total scores of mini-mental state examination (MMSE) dropped by more than 2 points from the acute phase (first fourteen days) to three months after stroke, and comparison was made between the two groups. Logistic regression analysis was applied to determine the risk factors for cognitive deterioration within the first three months after ischemic stroke. Results We found that 117 (60.0%) patients were diagnosed with post stroke cognitive impairment (PSCI) in the acute phase of ischemic stroke and 37 (19.0%) suffered cognitive deterioration within the first three months after ischemic stroke. Univariate logistic regression analysis suggested that the deterioration was significantly associated with age, sex, years of education, MMSE in the acute phase, clinical dementia rating scale (CDR) scores in the acute phase and the level of glycosylated hemoglobin at admission (P<0.05). Multivariate logistic regression analysis suggested that age (>70 years old) (RR=2.509,P=0.045), illiteracy (RR=3.038,P=0.011) and the level of glycosylated hemoglobin (RR=1.364,P=0.016) in the acute phase were the risk factors for cognitive deterioration within three months after ischemic stroke,and high score of MMSE was a protective factor for cognitive deterioration within three months after ischemic stroke (RR=0.852, P=0.001). Conclusion The risk factors for early-stage cognitive deterioration after ischemic stroke include age (>70 years old), illiteracy, high level of glycosylated hemoglobin and serious cognitive impairment in the acute phase.