Frequency, Determinants, and Consequences of Anosognosia in Acute Stroke
Frequency, Determinants, and Consequences of Anosognosia in Acute Stroke
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急性中风中失认症的频率、决定因素和后果
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
T. Olsen
中科院分区：
文献类型：
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作者：
P. M. Pedersen;H. S. Jørgensen;H. Nakayama;H. Raaschou;T. Olsen
病感失认症是卒中后众所周知的症状，但其在急性卒中后出现的频率尚不清楚，其对功能预后的影响的知识也有限。这项前瞻性研究包括566名连续的、未经选择的急性中风患者。急性入院时采用Bisiach等人的测验对厌食症进行评估。(1986)，卒中严重程度采用斯堪的纳维亚神经卒中量表(SNSS)，日常生活活动能力(ADLS)采用Barthel指数(BI)。进行多元线性和Logistic回归分析，找出病感失认症对卒中本身结果的影响。急性入院时病感失认症的发生率为21%。81%的患者病变位于右半球。在皮质损害后较皮质下损害更常见的是感觉失认症，但与四个皮质叶中的任何一个都没有明显的关系。病感缺失本身的存在预示着出院BI降低11.5分，住院期间死亡的可能性增加4.4倍，而独立生活的幸存者出院的可能性降低0.43。病感失认症在急性卒中中很常见，对预后有深远的影响，表明患者需要特别的鼓励和动员帮助。
Anosognosia is a well-known symptom after stroke but its frequency following acute stroke is not known and knowledge of its impact on functional outcome is limited. This prospective study included 566 consecutive, unselected, acute stroke patients. Anoso gnosia was evaluated on acute admission using the test of Bisiach et al. (1986), stroke severity with the Scandinavian Neurological Stroke Scale (SNSS), and activities of daily living (ADLs) with the Barthel Index (BI). Multiple linear and logistic regres sion analyses were done to find the influence of anosognosia on the outcome of stroke per se. The frequency of anosognosia was 21% on acute admission. The lesion was located in the right hemisphere in 81% of the patients. Anosognosia was seen more frequently following cortical vs. subcortical lesions but showed no significant rela tionship to any of the four cortical lobes. The presence of anosognosia per se predicted 11.5 points less in discharge BI, increased the likelihood of death during the hospital stay by a factor of 4.4, and reduced the likelihood of discharge to independent living in survivors by 0.43. Anosognosia is common in acute stroke, has a profound influence on the prognosis, and indicates patients needing special encouragement and assistance with mobilization.