Chaudhari Tejendra Sukdeo, Verma Rajesh, Garg Ravindra Kumar, Singh Manish Kumar, Malhotra Hardeep Singh, Sharma Praveen Kumar
Department of Neurology, King George's Medical University, Lucknow, UP, India.
Department of Neurology, King George's Medical University, Lucknow, UP, India.
J Neurol Sci. 2014 May 15;340(1-2):150-8. doi: 10.1016/j.jns.2014.03.018. Epub 2014 Mar 19.
Cognitive dysfunction occurs commonly following stroke and varies in severity. This study was aimed to determine the clinical, neuro-imaging, laboratory predictors of post stroke cognitive impairment and factors related to poor functional outcome in patients with post-stroke vascular cognitive impairment (VCI).
We prospectively evaluated 102 of 240 consecutive stroke patients for 6 months after incident stroke for development of VCI. Patients with VCI comprised of those with VCI-no dementia (VCIND) and vascular dementia (VaD). Functional outcome was assessed by modified Barthel index (MBI).
Frequency of post-stroke VCI was 45.1% (46/102): 26.5% (27/102) having VCI-ND and 18.6% (19/102) having VaD. Patients with VCI were more likely to have lower educational and socioeconomic status, diabetes, hypertension, prior stroke, multiple risk factors, urinary incontinence, gait abnormality, peripheral signs of atherosclerosis, higher blood sugar level on admission and LDL levels, strategic site lesion, higher ARWMC (age related white matter changes) score, worse stroke severity (NIHSS) and functional outcome scores. On logistic regression analysis, lower educational status, strategic site lesion, higher ARWMC score and baseline stroke severity score were found to independently predict the risk of developing VCI. Worse stroke severity (NIHSS) scores and functional status scores at baseline predicted poor outcome in patients with VCI.
Post-stroke cognitive impairment is frequent and is associated with poor functional outcome. Predictors like lower educational status, strategic site lesion, greater severity of age related white matter changes and baseline stroke severity independently contributed to the risk of developing VCI in stroke patients.
认知功能障碍在中风后很常见，且严重程度各异。本研究旨在确定中风后认知障碍的临床、神经影像学、实验室预测指标，以及中风后血管性认知障碍（VCI）患者功能预后不良的相关因素。
我们对240例连续中风患者中的102例进行了前瞻性评估，在中风发病后6个月观察VCI的发生情况。VCI患者包括无痴呆的VCI（VCIND）和血管性痴呆（VaD）患者。通过改良巴氏指数（MBI）评估功能预后。
中风后VCI的发生率为45.1%（46/102）：26.5%（27/102）为VCIND，18.6%（19/102）为VaD。VCI患者更可能具有较低的教育程度和社会经济地位、糖尿病、高血压、既往中风史、多种危险因素、尿失禁、步态异常、动脉粥样硬化的外周体征、入院时较高的血糖水平和低密度脂蛋白水平、关键部位病变、较高的年龄相关白质改变（ARWMC）评分、更严重的中风严重程度（美国国立卫生研究院卒中量表[NIHSS]）和功能预后评分。逻辑回归分析发现，较低的教育程度、关键部位病变、较高的ARWMC评分和基线中风严重程度评分可独立预测发生VCI的风险。基线时更严重的中风严重程度（NIHSS）评分和功能状态评分可预测VCI患者的不良预后。
中风后认知障碍很常见，且与功能预后不良相关。较低的教育程度、关键部位病变、年龄相关白质改变的更严重程度和基线中风严重程度等预测指标独立增加了中风患者发生VCI的风险。
