COGNITIVE IMPAIRMENT AFTER STROKE - FREQUENCY, PATTERNS, AND RELATIONSHIP TO FUNCTIONAL ABILITIES
COGNITIVE IMPAIRMENT AFTER STROKE - FREQUENCY, PATTERNS, AND RELATIONSHIP TO FUNCTIONAL ABILITIES
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DOI：
10.1136/jnnp.57.2.202
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发表时间：
1994-02-01
影响因子：
11
通讯作者：
BAGIELLA, E
中科院分区：
文献类型：
--
作者：
TATEMICHI, TK;DESMOND, DW;BAGIELLA, E
对227例缺血性卒中患者入院三个月后的认知功能进行了检测，并与240例非卒中对照组进行了比较，采用17个评分项目评估了记忆、定向、言语技能、视觉空间能力、抽象推理和注意力技能。在调整了所有受试者标准化剩余分数的人口统计学因素后，控制组的第五个百分位数被用作每个项目不及格的标准。中风患者的平均失败项目数(SD)为3.4(3.6)，对照组(P<；0.001)为0.8(1.3)。认知障碍，定义为在任何四个或更多的项目上失败，在35.2%的中风患者和3.8%的对照组中发生(p<；0.001)。与对照组相比，中风患者最有可能存在缺陷的认知领域是记忆、定向、语言和注意力。在中风患者中，认知障碍最常与主要皮质综合征和左侧大脑前动脉和大脑后动脉区域的脑梗塞有关。认知功能损害更大，出院后在家或养老院依赖生活的可能性更大(55.0%有认知障碍，32.7%无认知障碍，p=0.001)。在检验中风后依赖生活的风险的Logistic模型中，在调整了年龄(OR=5.2，80+v60-70岁)和身体损伤(OR=3.7，Barthel指数小于或等于40v>；40)后，认知障碍是一个显著的独立相关因素(优势比，OR=2.4)。结论：卒中后认知功能障碍频繁发生，主要涉及记忆、定向、语言和注意力。在生物统计学中，中风患者认知损害的存在的划分具有重要的功能后果，独立于身体损害的影响。对卒中结果和干预措施的研究应同时考虑认知和身体损害。
Cognitive function was examined in 227 patients three months after admission to hospital for ischaemic stroke, and in 240 stroke-free controls, using 17 scored items that assessed memory, orientation, verbal skills, visuospatial ability, abstract reasoning, and attentional skills. After adjusting for demographic factors with standardised residual scores in all subjects, the fifth percentile was used for controls as the criterion for failure on each item. The mean (SD) number of failed items was 3.4 (3.6) for patients with stroke and 0.8 (1.3) for controls (p < 0.001). Cognitive impairment, defined as failure on any four or more items, occurred in 35.2% of patients with stroke and 3.8% of controls (p < 0.001). Cognitive domains most likely to be defective in stroke compared with control subjects were memory, orientation, language, and attention. Among patients with stroke, cognitive impairment was most frequently associated with major cortical syndromes and with infarctions in the left anterior and posterior cerebral artery territories. Functional impairment was greater with cognitive impairment, and dependent living after discharge either at home or nursing home was more likely (55.0% with, v 32.7% without cognitive impairment, p = 0.001). In a logistic model examining the risks related to dependent living after stroke, cognitive impairment was a significant independent correlate (odds ratio, OR = 2.4), after adjusting for age (OR = 5.2, 80 + v 60-70 years) and physical impairment (OR = 3.7, Barthel index less than or equal to 40 v > 40). It is concluded that cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention. Division of The presence of cognitive impairment in Biostatistics patients with stroke has important functional consequences, independent of the effects of physical impairment. Studies of stroke outcome and intervention should take into account both cognitive and physical impairments.