Predictors of cognitive dysfunction after subarachnoid hemorrhage
Predictors of cognitive dysfunction after subarachnoid hemorrhage
复制标题
DOI：
10.1161/hs0102.101080
复制
发表时间：
2002-01-01
期刊：
影响因子：
8.3
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Kreiter, KT;Copeland, D;Mayer, SA
背景：认知功能障碍是蛛网膜下腔出血（SAH）常见的致残性后遗症。尽管一些临床和影像学发现与SAH后认知功能障碍的发病机制有关，但很少有前瞻性研究全面、同时评估这些危险因素。方法：在1996年7月至2000年3月期间，我们对248例连续入院的非创伤性SAH患者中的113例进行了前瞻性评估，并进行了全面的神经心理学评估。计算8个认知领域的总成绩，以表示相对于整个研究人群的测试成绩。在控制人口统计学因素影响的情况下，采用前向逐步多元回归方法确定与特定领域认知功能障碍相关的临床和影像学变量。结果：研究参与者更年轻（P=0.005），白人较少（P=0.006）， 3个月修正Rankin评分（P=0.001）优于未接受神经心理测试的参与者。每项神经心理测试得分在受损范围（低于规范平均值bbb20 SD）的受试者比例在10%至50%之间。在多变量分析中，2个或更多脑域认知功能障碍的预测因子包括全局性脑水肿（4个脑域）、左侧脑梗死（3个脑域）和缺乏后循环动脉瘤（2个脑域）。在单变量分析中，与认知功能障碍一致相关的其他变量包括入院Hunt-Hess分级>2和前半球间裂和脑外侧裂的厚SAH。结论：脑水肿和左侧脑梗死是SAH后认知功能障碍的重要危险因素。治疗策略旨在减少与广泛性脑肿胀、梗死和血块相关的血液毒性相关的神经损伤，对改善SAH后的认知结果最有希望。
Background-Cognitive dysfunction is a common and disabling sequela of subarachnoid hemorrhage (SAH). Although several clinical and radiographic findings have been implicated in the pathogenesis of cognitive dysfunction after SAH, few prospective studies have comprehensively and simultaneously evaluated these risk factors.Methods-Between July 1996 and March 2000, we prospectively evaluated 113 of 248 consecutively admitted nontraumatic SAH patients alive at 3 months with a comprehensive neuropsychological evaluation. Summary scores for 8 cognitive domains were calculated to express test performance relative to the entire study population. Clinical and L radiographic variables associated with domain-specific cognitive dysfunction were identified with forward stepwise multiple regression, with control for the influence of demographic factors.Results-The study participants were younger (P=0.005), less often white (P=0.006), and had better 3-month modified Rankin scores (P=0.001) than those who did not undergo neuropsychological testing. The proportion of subjects who scored in the impaired range (>2 SD below the normative mean) on each neuropsychological test ranged from 10% to 50%. Predictors of cognitive dysfunction in 2 or more domains in the multivariate analysis included global cerebral edema (4 domains), left-sided infarction (3 domains), and lack of a posterior circulation aneurysm (2 domains). Other variables consistently associated with cognitive dysfunction in the univariate analysis included admission Hunt-Hess grade >2 and thick SAH in the anterior interhemispheric and sylvian fissures.Conclusions-Global cerebral edema and left-sided infarction are important risk factors for cognitive dysfunction after SAH. Treatment strategies aimed at reducing neurological injury related to generalized brain swelling, infarction, and clot-related hemotoxicity hold the best promise for improving cognitive outcomes after SAH.