初次发病的腔隙性脑梗死患者的认知变化特点

目的研究初次发病的腔隙性脑梗死(lacunar infarction,LI)患者的认知变化特点。方法64例初次发病的腔隙性脑梗死患者分别于腔隙性脑梗死发病1周内〔(4.70±1.70)d〕、发病后1月〔(32.71±4.54)d〕、3月〔(94.53±6.65)d〕、6月〔(177.30±9.21)d〕和12月〔(364.29±7.94)d〕进行了5次神经心理学测验,与78例正常人进行比较,观察不同时期认知的变化特点。神经心理学测验包括简易精神状态检查量表、汉化的韦氏成人智力量表(数字广度、图片排列、数字符号和积木测验)、世界卫生组织-加利福尼亚洛杉矶大学听觉词语学习测验、简化的Rey复杂图形测验、Stroop测验、语义分类流畅性测验、加利福尼亚卡片分类测验和画钟测验,涵盖了注意力、记忆力、执行能力、信息处理速度、视空间结构能力等认知域。结果腔隙性脑梗死不同时期的认知评分分别与对照组进行比较,急性期(发病1周内)在记忆力、执行能力和视空间结构能力等认知域均差于对照组(P<0.05)。随时间变化,记忆力和大部分执行能力于发病后1～3月内好转并恢复至正常水平;执行能力中的数字广度倒背分测验和视空间结构能力中的大部分测验(图形临摹和画钟测验)在发病后12月内认知评分始终无好转;个别执行能力(语义分类流畅性测验和加利福尼亚卡片分类测验)于发病后12月时再次加重;注意力和信息处理速度于发病后12月内始终处于正常水平。结论腔隙性脑梗死急性期认知损害广泛而严重;腔隙性脑梗死后认知障碍大部分恢复较快,于1～3月内恢复至正常,执行能力和视空间结构能力出现了不可逆的损害或好转后再次加重。腔隙性脑梗死后的认知障碍值得重视和早期干预。

Cognitive Characteristics in Patients with the First-ever Lacunar Cerebral Infarction

Objective To investigate the characteristics and changes of the cognitive impairment in patients with the first ever lacunar cerebral infarction(LI). Methods Neuropsychological evaluation was conducted within 1 week(4.70±1.70)days, 1 month brain〔(32.71±4.54)days〕, 3 months〔(94.53±6.65)days〕, 6 months〔(177.30±9.21)days〕 and 12 months〔(364.29±7.94)days〕 after lacunar infarction for 64 patients. The scores were compared with the baseline and those of 78 healthy controls. The comprehensive neuropsychological evaluation battery included mini mental state examination, Chinese version of Wechsler adult intelligence scale(digit span, picture arrangement, digit sign and block design), World Health Organization University of California-Los Angeles auditory verbal learning test, Rey complex figure test, stroop test, semantic category verbal fluency test, California card sorting test and clock drawing test, which contains tests for attention, memory, executive function, information processing speed, visuospatial and visuo constructive function. Results Compared with healthy controls, significant difference was found on the memory, executive function, visuospatial and visuo-constructive function in acute stage of lacunar cerebral infarction. The cognitive function was improved significantly and returned to normal on the memory and most executive function since 1 to 3 months after attack. WAIS-RC digit span backwards subtest and most visuospatial and visuo-constructive function tests(figures copying and clock drawing test) was not improved during 12 months. Some of executive function (semantic category verbal fluency and California card sorting test) aggravated again at 12 months after attack. Information processing speed and attention were preserved through the course. Conclusion In acute stage of lacunar cerebral infarction, the cognitive impairment was extensive and severe. Most cognitive domains were improved in 1 to 3 months. Executive function, visuospatial and visuo constructive function impaired irreversibly or aggravated again. The patients with cognitive impairment after lacunar cerebral infarction needed more attention and intervention early.