Engstad Torgeir, Viitanen Matti, Almkvist Ove
Geriatrisk avdeling, Universitetssykehuset Nord-Norge, 9038 Tromsø.
Tidsskr Nor Laegeforen. 2007 May 17;127(10):1390-3.
An incidence of stroke is often followed by cognitive impairment. This review article presents an update about such impairment and emphasises diagnostical and therapeutical challenges.
This article is based mainly on literature identified on Medline using the terms "cognitive impairment and stroke," "dementia and stroke," "vascular dementia" and "vascular cognitive impairment."
Cognitive impairment after stroke varies with respect to cerebral localisation and the magnitude of injured brain tissue, and may be classified according to neuropsychological profile and neuroanatomical damage. The cognitive domains affected are in particular executive functions, motor and psychomotor abilities (mapped by speeded tests) and attention. Executive function comprises planning, organising, conducting, assessing and controlling actions. The neuropathological basis for these cognitive domains is mainly located in frontal subcortical brain areas. Cognitive impairment can be identified using neuropsychological tests as verbal fluency (FAS) corresponding to executive function, digit span (psychomotor abilities) and finger-tapping (motor speed). The Mini Mental State Examination test is of limited diagnostic help, but is recommended due to the need of a global cognitive functioning measure. The treatment recommended comprises sound measures for secondary prevention of stroke directed towards vascular risk factors. Non-pharmaceutical intervention such as physical training, cognitive and social stimulation probably has a greater therapeutic potential than normally assumed.
中风发作后常伴有认知障碍。这篇综述文章介绍了有关此类障碍的最新情况，并强调了诊断和治疗方面的挑战。
本文主要基于通过在Medline上使用“认知障碍与中风”“痴呆与中风”“血管性痴呆”和“血管性认知障碍”等术语检索到的文献。
中风后的认知障碍因脑定位和受损脑组织的程度而异，可根据神经心理学特征和神经解剖损伤进行分类。受影响的认知领域尤其包括执行功能、运动和精神运动能力（通过快速测试来衡量）以及注意力。执行功能包括计划、组织、实施、评估和控制行动。这些认知领域的神经病理学基础主要位于额叶皮质下脑区。可通过神经心理学测试来识别认知障碍，如对应执行功能的言语流畅性（FAS）、数字广度（精神运动能力）和手指敲击（运动速度）。简易精神状态检查表的诊断帮助有限，但由于需要一种全面的认知功能测量方法，仍被推荐使用。推荐的治疗方法包括针对血管危险因素的中风二级预防的合理措施。非药物干预，如体育锻炼、认知和社交刺激，可能具有比通常认为的更大的治疗潜力。
