Liao Xiao-Ling, Zuo Li-Jun, Zhang Ning, Yang Yang, Pan Yue-Song, Xiang Xiang-Long, Chen Ling-Yun, Meng Xia, Li Hao, Zhao Xing-Quan, Wang Yi-Long, Wang Chun-Xue, Shi Jiong, Wang Yong-Jun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Neuropsychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Mar 26;16:807-814. doi: 10.2147/NDT.S234544. eCollection 2020.
More and more evidence suggests that cognitive impairment (CI) after stroke is closely related to the quality of life of stroke patients. The primary aim of this study is to investigate the occurrence and longitudinal changes of CI at different stages after acute ischemic stroke (AIS) in Chinese patients.
The data of this study come from the impairment of cognition and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients study (ICONS), a nationwide multicenter prospective registry that recruited consecutive AIS or transient ischemic attack in-hospital patients within 7 days after onset. Patients were followed for Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3m) and 12 months (12m). CI was defined as MoCA score≦22. No cognitive impairment (NCI) was defined as MoCA score>22.
A total of 2432 AIS patients were enrolled in this study. Overall, 72.94% of patients were male and the average age was 60.95 years. Median National Institutes of Health Stroke Scale score was 3. The occurrence rate of CI was 52.38%, 35.55% and 34.16% at 2w, 3m and 12m. Among patients with CI at 2w and 3m, 39.9% and 27.9% of patients returned to NCI at next follow-up point. At 3m and 12m follow-up, there were also 9.6% and 12.7% new CI patients. The two cognitive items with the highest abnormal rate were "Delayed recall" (89.35%, 83.33% and 82.80%) and "Visuospatial/executive" (78.91%, 73.42% and 70.08%). The cognitive item with the highest percentage of improved patients was "Orientation" (60.91-76.68%), and the cognitive item with the lowest percentage of improved patients was "Language" (35.85-44.50%).
CI had a relatively high occurrence at 2w to 12m after AIS. CI at 3m and 12m was significantly lower than that at 2w after stroke. The occurrence of abnormalities and recovery probability for different cognitive items also differed greatly.
越来越多的证据表明，卒中后认知障碍（CI）与卒中患者的生活质量密切相关。本研究的主要目的是调查中国急性缺血性卒中（AIS）患者在不同阶段CI的发生情况及纵向变化。
本研究的数据来自中国急性缺血性卒中或短暂性脑缺血发作患者的认知与睡眠障碍研究（ICONS），这是一项全国性多中心前瞻性登记研究，纳入发病后7天内连续入院的AIS或短暂性脑缺血发作患者。在2周（2w）、3个月（3m）和12个月（12m）时对患者进行蒙特利尔认知评估（MoCA）量表随访。CI定义为MoCA评分≤22。无认知障碍（NCI）定义为MoCA评分>22。
本研究共纳入2432例AIS患者。总体而言，72.94%的患者为男性，平均年龄为60.95岁。美国国立卫生研究院卒中量表评分中位数为3。CI的发生率在2w、3m和12m时分别为52.38%、35.55%和34.16%。在2w和3m时有CI的患者中，分别有39.9%和27.9%的患者在下一个随访点恢复为NCI。在3m和12m随访时，也分别有9.6%和12.7%的新CI患者。异常率最高的两个认知项目是“延迟回忆”（89.35%、83.33%和82.80%）和“视觉空间/执行功能”（78.91%、73.42%和70.08%）。改善患者比例最高的认知项目是“定向力”（60.91 - 76.68%），改善患者比例最低的认知项目是“语言”（35.85 - 44.50%）。
AIS后2w至12m时CI的发生率相对较高。卒中后3m和12m时的CI明显低于2w时。不同认知项目的异常发生情况及恢复概率也有很大差异。
