Viršužiglis Hospital of Rehabilitation, affiliate of Hospital of Lithuanian University of Health Sciences, Pilėnų 2, Sietyno vill., 53192 Kaunas distr., Lithuania.
Medicina (Kaunas). 2011;47(9):486-93. Epub 2011 Dec 13.
The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients.
The study sample comprised 226 stroke patients at the Viršužiglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment.
More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status.
During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment.
本研究旨在评估认知障碍程度对脑卒中患者功能状态恢复和第二阶段康复效果的影响。
研究样本包括立陶宛健康科学大学 Viršužiglis 医院康复病房的 226 例脑卒中患者。采用功能独立性评定量表(FIM)评估功能状态,采用简易精神状态检查量表(MMSE)评估认知功能,采用国立卫生研究院卒中量表(NIHSS)评估神经功能缺损严重程度。根据认知障碍程度将患者分为 4 个研究组:严重、中度、轻度或无认知障碍。
所有患者中有一半以上(53%)存在认知障碍,且不同程度认知障碍患者的分布较为均衡:轻度障碍(18%)、中度障碍(17%)和严重障碍(18%)。所有研究组的功能状态均有改善(P<0.001)。在中重度认知障碍患者中,认知恢复明显更为显著(P<0.001)。功能状态恢复不足与偏瘫(OR=11.15,P=0.015)、尿失禁(OR=14.91,P<0.001)、关节疾病(OR=5.52,P=0.022)、心脏病(OR=4.10,P=0.041)和严重认知障碍(OR=15.18,P<0.001)显著相关,而中轻度认知障碍与功能状态恢复无关。
在脑卒中患者第二阶段康复过程中,无论是否存在认知障碍,功能状态以及认知和运动技能均得到改善;然而,在第二阶段康复开始时即被诊断为严重或中度认知障碍的患者,在整个第二阶段康复过程中,神经功能和功能状态均较轻度或无认知障碍患者差。