受教育水平对急性脑血管病患者认知功能的保护作用

背景一些研究已经证明脑血管病后认知功能不仅受脑损害自身的影响,还受一些社会经济因素影响,受教育水平可能是一重要因素.目的通过分析急性脑血管病(acutecerebrovascular disease,ACVD)患者受教育时间与认知功能障碍的关系,探讨正规教育对ACVD患者认知功能损害的保护价值.设计以诊断为依据,病例对照研究.地点和对象1997-01/2002-06大坪医院神经科所收治183例ACVD患者.方法由作者本人用老年认知功能量表(scaleof elderly cognitivefunction.SECF)和简易精神状态量表(mini-mental stateexamination,MMSE)检测ACVD患者的认知功能,并用SPSS10.0软件进行数据分析.主要观察指标正规受教育时间、SECF各量表粗分、T分和MMSE评分.结果除识记外ACVD患者的SECF评分明显低于对照组(P＜0.01),其异常率为23.1%～48.5%,与对照组(0～16.3%)比较差异有显著性意义(P＜0.01);MMSE异常率26%,与SECF总分粗分异常率48.5%比较差异有显著性意义(P＜0.01).除广度外受教育水平与ACVD患者的SECF的各粗分和T分呈明显正相关(r=0.16-0.33,P＜0.01);粗分方差分析显示,未受教育组的定向、计算、临摹和分类四项评分均明显低于另4个组(P＜0.01),余分量表评分为≤6年明显低于＞6年组(P＜0.05～0.0001).T分的组间比较为广度、计算各组间无明显差异(P＞0.05),临摹、言语仅个别组间有差异(P＜0.01),余分量表主要显示≤9年教育组评分明显低于＞9年组(P＜0.01).结论ACVD患者各项认知功能明显受损;受教育水平对瞬时记忆、注意、语言和空间认知功能无明显影响,而短时、长时记忆和特定范围的信息提取能力明显受文化程度影响,9年以上正规教育对这些功能有保护作用.

Protective role ofeducation background in the cognitive function of acute cerebrovascular disease patients

BACKGROUND: Some researches have proved that the cognitive function after cerebrovascular diseases is affected not only by cerebral impairment itself but also some social economic factors. Education background might be an important factor.OBJECTIVE: To discuss the protective merits of normal education in cognitive impairment through analysing the relationship between educational level and cognitive impairment in acute cerebrovascular disease(ACVD) patients.DESIGN: A case-control study based on diagnosisSETTING and PARTICIPANTS: Totally 183 ACVD patients admitted by Neurology Department of Daping Hospital from January 1997 to June 2002 were selected.METHODS: The cognitive function of ACVD patient was evaluated by the author with scale of elderly cognitive function(SECF) and mini-mental state examination(MMSE). Data was analysed by SPSS 10. 0 software.MAIN OUTCOME MEASURES: Normal education level, SECF scale original score, T score and MMSE scoreRESULTS: SECF scores of ACVD patients were significantly lower than those of control group except acquisition( P ＜ 0. 01 ), and the abnormal rate was between 23.1% and 48.5%, which had significance compared with that of control group(0 - 16.3%, P ＜ 0. 01). The abnormal rate of MMSE was 26%,which had significance compared with the abnormal rate of SECF original score (48.5%, P ＜ 0. 01). Education level had significant positive correlation with SECF original score and T score except digit span in ACVD patients( r =0. 16 - 0. 33, P ＜ 0. 01). The analysis of variance for original score revealed that the scores for four items, orientation, calculation, imitation and classification, were significantly lower in unschooled group than that of in the other four groups( P ＜ 0. 01); the rest of scale in 6-year or less education group were significantly lower than that in more than 6-year education group( P ＜ 0. 05 -0. 000 1). There were no significant differences in digit span and calculation in T score( P ＞ 0. 05). The significant differences of imitating and language were only between one or two groups( P ＜ 0. 01 ), and the rest of the items mainly revealed that scores in 9-year or less education group were distinctly lower than those in 9-year or more education group( P ＜ 0. 01).CONCLUSION: All items of cognitive function in ACVD patients are signfficantly damaged. Education level has no significant effect on immediate memory, attention, language and space cognition. However, short-term,long-term recall and the ability of information abstraction in certain extents are significantly affected by education level. Nine-year or more normal education has protective reaction to these functions.