The Sahlgrenska Academy, University of Gothenburg, Institution of Medicine, Gothenburg, Sweden.
Disabil Rehabil. 2011;33(21-22):1952-62. doi: 10.3109/09638288.2011.553703. Epub 2011 Feb 9.
The ability to balance is no longer automatic after stroke in patients with motor impairment and needs to be relearned. Learning requires cognitive and executive abilities. It is well known that cognitive and executive impairments are common after stroke, but how these are related to balance has not yet been fully studied. We, therefore, wanted to explore the impact of pre-stroke cognitive impairment, global and selective cognitive and executive impairment in the early phase after stroke and at the 1-year follow-up on balance and on the improvement of balance during the first year after stroke.
Seventy-four patients were included consecutively on admission following stroke to a geriatric stroke unit and followed prospectively for 1 year. Balance was assessed using the Berg Balance Scale on admission, on discharge and 1 year after stroke.
Cognitive impairment before stroke, measured using the Cognitive Impairment Questionnaire, was found to lead to poor balance on discharge and 1 year after stroke. Patients with impaired logical deductive ability and executive function, measured using a neuropsychological test battery both in the early phase and 1 year after stroke, also had significantly poorer balance 1 year after stroke than patients with intact functions. Most importantly, only patients with intact cognitive function, before stroke, on admission and at the 1-year follow-up, significantly improved their balance after discharge.
Our results show that cognitive status, both before and after stroke, is important for balance and improvement of balance after stroke.
运动障碍的脑卒中患者平衡能力不再是自动的，需要重新学习。学习需要认知和执行能力。众所周知，认知和执行障碍在脑卒中后很常见，但它们与平衡的关系尚未得到充分研究。因此，我们想探讨脑卒中前认知障碍、脑卒中后早期的整体和选择性认知及执行障碍，以及 1 年随访时对平衡和脑卒中后 1 年平衡改善的影响。
74 例患者连续入院至老年脑卒中病房，并前瞻性随访 1 年。在入院时、出院时和脑卒中后 1 年使用 Berg 平衡量表评估平衡。
脑卒中前使用认知障碍问卷测量的认知障碍与出院时和脑卒中后 1 年的平衡不良有关。脑卒中后早期和 1 年时使用神经心理学测试组合测量的逻辑推理能力和执行功能受损的患者，其平衡在脑卒中后 1 年也明显更差，而功能正常的患者则没有。最重要的是，只有在脑卒中前、入院时和 1 年随访时认知功能正常的患者，在出院后平衡才显著改善。
我们的结果表明，脑卒中前后的认知状态对平衡和脑卒中后平衡的改善很重要。
