Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Klong 1, Klong Luang, Pathumthani 12120, Thailand; Faculty of Medicine, Chulabhorn International College of Medicine, Thammasat University, Klong 1, Klong Luang, Pathumthani 12120, Thailand.
J Stroke Cerebrovasc Dis. 2021 Oct;30(10):106027. doi: 10.1016/j.jstrokecerebrovasdis.2021.106027. Epub 2021 Aug 10.
Only a few studies longitudinally evaluated all cognitive domains after acute stroke. The purpose was to study the changes in cognitive function after acute stroke.
Cognitive assessment, using Thai mental state examination (TMSE) and Montreal Cognitive Assessment (MOCA), was performed at the acute stroke, and at 3 and 6 months after stroke. Cognitive domains were evaluated by MOCA subcategory score. TMSE and MOCA were compared at different stages of stroke and in among those with normal cognition (NC), vascular mild cognitive impairment (VMCI) and vascular dementia (VAD).
138 patients were included. At 6 months, 32 patients (23%) had NC. VMCI and VAD were diagnosed in 76 patients (55%), and 30 patients (22%), respectively. Total scores of TMSE and MOCA were higher at 3 months as compared to at the acute stroke (TMSE; 24.85 vs 23.01, p-value <0.001, MOCA; 19.30 vs 16.49, p-value <0.001), and higher TMSE, but not MOCA, at 6 months as compared to at 3 months (TMSE; 25.35 vs 24.85, p-value= 0.021, MOCA; 19.04 vs 19.30, p-value= 0.058). Changes in total scores at early stroke were highest in NC. VMCI and VAD patients had cognitive impairment in all cognitive domains.
Cognitive impairment was highest at the acute stroke and improved during early recovery. The greatest rate of improvement occurred within 3 months. Improvement was found in all cognitive domains.
仅有少数研究对急性脑卒中后所有认知域进行了纵向评估。本研究旨在探讨急性脑卒中后认知功能的变化。
在急性脑卒中后及脑卒中后 3 个月和 6 个月时，采用泰国精神状态检查（TMSE）和蒙特利尔认知评估（MOCA）进行认知评估。采用 MOCA 亚类评分评估认知域。比较不同阶段脑卒中患者及认知正常（NC）、血管性轻度认知障碍（VMCI）和血管性痴呆（VAD）患者 TMSE 和 MOCA 的差异。
共纳入 138 例患者。6 个月时，32 例（23%）患者 NC，76 例（55%）和 30 例（22%）患者分别诊断为 VMCI 和 VAD。与急性脑卒中相比，3 个月时 TMSE 和 MOCA 总分升高（TMSE：24.85 比 23.01，p 值<0.001；MOCA：19.30 比 16.49，p 值<0.001），而 6 个月时 TMSE 升高，但 MOCA 无差异（TMSE：25.35 比 24.85，p 值=0.021；MOCA：19.04 比 19.30，p 值=0.058）。早期脑卒中时总分的变化在 NC 患者中最高。VMCI 和 VAD 患者所有认知域均存在认知障碍。
急性脑卒中时认知障碍最严重，在早期恢复过程中得到改善。3 个月内改善最明显，所有认知域均有改善。
