动脉瘤性蛛网膜下腔出血中的严重认知障碍：预测因素及其与功能结局的关系。
Severe cognitive impairment in aneurysmal subarachnoid hemorrhage: Predictors and relationship to functional outcome.
作者信息
Geraghty Joseph R, Lara-Angulo Melissa N, Spegar Milen, Reeh Jenna, Testai Fernando D
机构信息
Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States; Medical Scientist Training Program, University of Illinois at Chicago, Chicago, IL, United States.
Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, 912 S. Wood St. Suite 174N, Chicago, IL 60612, United States.
出版信息
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105027. doi: 10.1016/j.jstrokecerebrovasdis.2020.105027. Epub 2020 Jun 20.
BACKGROUND
Cognitive impairment is common after aneurysmal subarachnoid hemorrhage (SAH). However, compared to predictors of functional outcome, meaningful predictors of cognitive impairment are lacking.
OBJECTIVE
Our goal was to assess which factors during hospitalization can predict severe cognitive impairment in SAH patients, especially those who might otherwise be expected to have good functional outcomes. We hypothesized that the degree of early brain injury (EBI), vasospasm, and delayed neurological deterioration (DND) would predict worse cognitive outcomes.
METHODS
We retrospectively reviewed SAH patient records from 2013 to 2019 to collect baseline information, clinical markers of EBI (Fisher, Hunt-Hess, and Glasgow Coma scores), vasospasm, and DND. Cognitive outcome was assessed by Montreal Cognitive Assessment (MoCA) and functional outcomes by modified Rankin Scale (mRS) at hospital discharge. SAH patients were compared to non-neurologic hospitalized controls. Among SAH patients, logistic regression analysis was used to identify predictors of severe cognitive impairment defined as a MoCA score <22.
RESULTS
We screened 288 SAH and 80 control patients. Cognitive outcomes assessed via MoCA at discharge were available in 105 SAH patients. Most of these patients had good functional outcome at discharge with a mean mRS of 1.8±1.3. Approximately 56.2% of SAH patients had MoCA scores <22 compared to 28.7% of controls. Among SAH patients, modified Fisher scale was an independent predictor of cognitive impairment after adjustment for baseline differences (OR 1.638, p=0.043). MoCA score correlated inversely with mRS (r=-0.3299, p=0.0006); however, among those with good functional outcome (mRS 0-2), 48.7% still exhibited cognitive impairment.
CONCLUSIONS
Severe cognitive impairment is highly prevalent after SAH, even among patients with good functional outcome. Higher modified Fisher scale on admission is an independent risk factor for severe cognitive impairment. Cognitive screening is warranted in all SAH patients, regardless of functional outcome.
背景
认知障碍在动脉瘤性蛛网膜下腔出血（SAH）后很常见。然而，与功能预后的预测因素相比，缺乏有意义的认知障碍预测因素。
目的
我们的目标是评估住院期间哪些因素可预测SAH患者的严重认知障碍，尤其是那些原本预期功能预后良好的患者。我们假设早期脑损伤（EBI）的程度、血管痉挛和延迟性神经功能恶化（DND）可预测更差的认知预后。
方法
我们回顾性分析了2013年至2019年SAH患者的病历，以收集基线信息、EBI的临床指标（Fisher、Hunt-Hess和格拉斯哥昏迷评分）、血管痉挛和DND。出院时通过蒙特利尔认知评估（MoCA）评估认知预后，通过改良Rankin量表（mRS）评估功能预后。将SAH患者与非神经系统住院对照进行比较。在SAH患者中，采用逻辑回归分析确定严重认知障碍（定义为MoCA评分<22）的预测因素。
结果
我们筛选了288例SAH患者和80例对照患者。105例SAH患者出院时通过MoCA评估了认知预后。这些患者中的大多数出院时功能预后良好，平均mRS为1.8±1.3。约56.2%的SAH患者MoCA评分<22，而对照患者为28.7%。在SAH患者中，调整基线差异后，改良Fisher量表是认知障碍的独立预测因素（OR 1.638，p=0.043）。MoCA评分与mRS呈负相关（r=-0.3299，p=0.0006）；然而，在功能预后良好（mRS 0-2）的患者中，48.7%仍存在认知障碍。
结论
SAH后严重认知障碍非常普遍，即使在功能预后良好的患者中也是如此。入院时较高的改良Fisher量表是严重认知障碍的独立危险因素。所有SAH患者均需进行认知筛查，无论其功能预后如何。
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