Cognitive determinants of social functioning after a first ever mild to moderate stroke at vocational age
Cognitive determinants of social functioning after a first ever mild to moderate stroke at vocational age
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DOI：
10.1136/jnnp.2008.169672
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发表时间：
2009-08-01
影响因子：
11
通讯作者：
Jaillard, A.
中科院分区：
文献类型：
--
作者：
Hommel, M.;Miguel, S. T.;Jaillard, A.
背景和目的：大约三分之二的职业年龄中风患者的社会功能受损，甚至在首次轻度至中度中风几个月后。已知的社会功能的预测因素是中风初期的严重程度，焦虑和抑郁，以及迷你精神状态评估，这表明认知缺陷有助于中风后的社会功能障碍。本研究的目的是评估认知领域是否与社会功能相关，并确定社会功能障碍的认知预测因素。方法：74例首次中风后6个月的患者进行前瞻性研究。记录美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表、抑郁和焦虑。使用工作与社会适应量表（WSAS）记录社会功能。一个广泛的神经心理学测试电池探索一般认知功能，情景记忆，工具功能，执行功能和工作记忆。单变量比较评估了神经心理测试与WSAS得分之间的关系。采用有序逻辑回归确定WSAS的预测因素。结果：52例患者（70%；95%可信区间为58%至80%）抱怨工作和社交功能明显紊乱。在单变量比较中，一般认知功能、记忆、工具功能、执行功能和工作记忆与社会功能显著相关。工作记忆是受影响最大的领域。通过多变量建模，入院时NIHSS、医院焦虑抑郁量表和Owen's空间工作记忆测验是WSAS的独立预测因子。结论：所有认知领域都与社会功能有关，工作记忆是主要的认知决定因素。我们的研究结果表明，认知障碍会影响社会功能障碍，而社会功能障碍是生活质量的一个组成部分。
Background and aim: Social functioning is impaired in approximately two-thirds of stroke patients of vocational age, even several months after a first ever mild to moderate stroke. The known predictors of social functioning are initial stroke severity, anxiety and depression, and the Mini-Mental State Evaluation, suggesting that cognitive deficits contribute to post-stroke social dysfunctioning. The aim of this study was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning.Methods: 74 patients were prospectively included 6 months after a first ever stroke. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale, depression and anxiety were recorded. Social functioning was recorded using the Work and Social Adjustment Scale (WSAS). An extensive neuropsychological test battery explored general cognitive functioning, episodic memory, instrumental functions, executive functions and working memory. Univariate comparisons assessed the relationships between the neuropsychological tests and scores on the WSAS. Predicting factors for WSAS were determined using ordinal logistic regression.Results: 52 patients (70%; 95% confidence interval 58% to 80%) complained of significant perturbations in work and social functioning. In univariate comparisons, general cognitive functioning, memory, instrumental functions, executive functions and working memory significantly correlated with social functioning. Working memory was the most affected domain. With multivariate modelling, the NIHSS at admission, Hospital Anxiety Depression scale and Owen's Spatial Working Memory test were independent predictors of WSAS.Conclusions: All cognitive domains were associated with social functioning, working memory being the main cognitive determinant. Our results suggest that cognitive impairment impacts on social dysfunctioning, which is known to be a component of quality of life.