轻度中风后的早期认知障碍：相关因素及功能结局

Early Cognitive Impairment after Minor Stroke: Associated Factors and Functional Outcome.

作者信息

Suda Satoshi, Nishimura Takuya, Ishiwata Akiko, Muraga Kanako, Aoki Junya, Kanamaru Takuya, Suzuki Kentaro, Sakamoto Yuki, Katano Takehiro, Nishiyama Yasuhiro, Mishina Masahiro, Kimura Kazumi

机构信息

Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.

出版信息

J Stroke Cerebrovasc Dis. 2020 May;29(5):104749. doi: 10.1016/j.jstrokecerebrovasdis.2020.104749. Epub 2020 Mar 14.

DOI:10.1016/j.jstrokecerebrovasdis.2020.104749

PMID:32178931

Abstract

OBJECTIVES

Evaluation of cognitive status is not performed routinely in the acute stroke setting. This study aimed to evaluate the frequency of early cognitive impairment in patients with minor ischemic stroke, analyze the factors associated with early cognitive impairment, and assess functional outcomes.

METHODS

In this prospective study, 112 consecutive patients with acute minor ischemic stroke were enrolled. Neuroimages were assessed for semiquantitative evaluation of brain atrophy and small vessel disease (SVD) markers. Cognitive performance was measured within 5 days of onset using Montreal Cognitive Assessment (MoCA) scores. Functional outcome analyses were adjusted for demographic variables, premorbid cognitive status, education level, vascular risk factors, neuroimaging characteristics, stroke severity, and MoCA scores.

RESULTS

The median MoCA score was 22, and 63% of patients had cognitive impairment. Factors independently associated with cognitive impairment were education (odds ratios [OR], .79; confidence intervals [CI], .63-.99), smoking (OR, .26; 95%CI, .073-.89), and temporal horn atrophy (OR, 4.73; 95% CI, 1.66-13.49). Factors independently associated with poor functional outcome were total MoCA score (OR, .78; 95%CI, .62-.95) and the sum of 4 MoCA subscores (visuospatial/executive, attention, language, and orientation; OR, .72; 95%CI, .53-.92). The cutoff value of the sum of 4 MoCA subscores for predicting poor outcome was 13 points with 76.5% sensitivity and 81.1% specificity.

CONCLUSIONS

Early cognitive impairment was common after minor ischemic stroke and was associated with preexisting temporal horn atrophy but not SVD markers. The sum of 4 MoCA subscores was useful in predicting the functional outcome.

摘要

目的

在急性卒中情况下，认知状态评估并非常规进行。本研究旨在评估轻度缺血性卒中患者早期认知障碍的发生率，分析与早期认知障碍相关的因素，并评估功能结局。

方法

在这项前瞻性研究中，连续纳入了112例急性轻度缺血性卒中患者。对神经影像进行评估，以对脑萎缩和小血管病（SVD）标志物进行半定量评估。在发病5天内使用蒙特利尔认知评估（MoCA）评分来测量认知表现。对功能结局分析进行了人口统计学变量、病前认知状态、教育水平、血管危险因素、神经影像特征、卒中严重程度和MoCA评分的校正。

结果

MoCA评分中位数为22分，63%的患者存在认知障碍。与认知障碍独立相关的因素有教育程度（比值比[OR]，0.79；可信区间[CI]，0.63 - 0.99）、吸烟（OR，0.26；95%CI，0.073 - 0.89）和颞角萎缩（OR，4.73；95%CI，1.66 - 13.49）。与功能结局不良独立相关的因素有MoCA总分（OR，0.78；95%CI，0.62 - 0.95）和4个MoCA子评分（视觉空间/执行、注意力、语言和定向）之和（OR，0.72；95%CI，0.53 - 0.92）。预测不良结局的4个MoCA子评分之和的截断值为13分，敏感性为76.5%，特异性为81.1%。