Wang Yuan, Wang Yuliang, Ma Wenbin, Lu Shujun, Chen Jinbo, Cao Lili
Department of Neurology, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
Department of Neurology, Binzhou Medical University Hospital, Binzhou, People's Republic of China.
Neuropsychiatr Dis Treat. 2018 Mar 28;14:871-877. doi: 10.2147/NDT.S161792. eCollection 2018.
The relationship between cognitive impairment during the acute phase of first cerebral infarction and the development of long-term pseudobulbar affect (PBA) has not been elucidated. Therefore, in this study, we aimed to determine if cognitive impairment during the acute phase of cerebral infarction will increase the risk of long-term post-infarction PBA.
This was a nested case-control study using a prospective approach. A consecutive multicenter matched 1:1 case-control study of cognitive impairment cases following acute cerebral infarction (N=26) with 26 sex-, education years-, and age-matched controls. Univariate and multivariate conditional logistic regression analyses were performed to study the clinical features and changes in cognitive domain as well as the risk factors for PBA.
Long-term PBA was independently predicted by low Montreal cognitive assessment (MoCA) scores at baseline. Multivariable regression models showed that post-infarction low MoCA scores remained independent predictors of long-term PBA (odds ratio [OR]=0.72; 95% confidence interval [CI]=0.54-0.95; =0.018). Among all cognitive disorders, digit span test (DST) scores (OR=0.39; 95% CI=0.16-0.91, =0.030), StroopC time (OR=1.15; 95% CI=1.01-1.31; =0.037), and clock-drawing task (CDT) scores (OR=0.62; 95% CI=0.42-0.90; =0.013) were found to be the independent risk factors for PBA.
Cognitive impairment during the acute phase of cerebral infarction increased the risk of cerebral infarction-induced long-term PBA. Development of PBA was closely associated with executive function, attention, and visuospatial disorder.
首次脑梗死急性期的认知障碍与长期假性球麻痹（PBA）的发生之间的关系尚未阐明。因此，在本研究中，我们旨在确定脑梗死急性期的认知障碍是否会增加梗死后长期发生PBA的风险。
这是一项采用前瞻性方法的巢式病例对照研究。对急性脑梗死（N = 26）后认知障碍病例进行连续多中心1:1匹配病例对照研究，与26名性别、受教育年限和年龄匹配的对照进行比较。进行单因素和多因素条件逻辑回归分析，以研究临床特征和认知领域的变化以及PBA的危险因素。
基线时蒙特利尔认知评估（MoCA）得分低可独立预测长期PBA。多变量回归模型显示，梗死后低MoCA得分仍然是长期PBA的独立预测因素（优势比[OR]=0.72；95%置信区间[CI]=0.54 - 0.95；P = 0.018）。在所有认知障碍中，数字广度测试（DST）得分（OR = 0.39；95% CI = 0.16 - 0.91，P = 0.030）、StroopC时间（OR = 1.15；95% CI = 1.01 - 1.31；P = 0.037）和画钟试验（CDT）得分（OR = 0.62；95% CI = 0.42 - 0.90；P = 0.013）被发现是PBA的独立危险因素。
脑梗死急性期的认知障碍增加了脑梗死诱发长期PBA的风险。PBA的发生与执行功能、注意力和视觉空间障碍密切相关。
