The Relationship Between Cognitive Impairment And Activities Of Daily Living In Patients With Lacunar Infarction

Background:Nowadays, there are more and more patients with lacunar infarction. Lacunar infarction is the independent risk factor for secondary senile dementia, which influences patients cognitive function and activities of daily living(ADL).Objective:To investigate the status of patients with lacunar infarction in cognitive impairment and activities of daily living (ADL) ability. To identify the relationship between cognitive impairment and ADL in patients with lacunar infarction in order to improve the understanding of lacunar infarction, then to provide appropriate nursing care and improve cognitive function and the level of patients quality of life.Methods:One hundred and eighty-nine patients with lacunar infarction diagnosed with CT or MRI were recruited from April2011to December2011in either neurology clinic or examination center Shandong Provincial Hospital (121male,68female). The cognitive functions, including orientation, memory, attention, calculation, recall ability, linguistic capacity, visuospatial and executive function were measured by Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA). And the activities of daily living in all patients were assessed by the Activities of Daily Living Scale (ADL). Statistical analysis was performed by SPSS17.0, including descriptive statistics, correlation analysis and regression analysis. Significant level was at a=<0.05.Results:1. MMSE assay showed that59percent of patients got the full scores (30scores),34percent of patients got the scores between26and29, and the other7percent of patients got less than26scores. Recall ability, attention and calculation ability, orientation influenced the scores much more.27percent of patients lost scores in recall ability,12percent of patients lost scores in attention and calculation ability,10percent patients lost scores in orientation. Otherwise, the immediate memory, object denomination and language repeating lost scores less. These results showed that the patients had cognitive impairment, especially in recall ability, attention and calculation ability, orientation.2. The results of MoCA showed61percent of patients got the full scores (30scores),27percent of patients got the scores between26and29, and the other12percent of patients got less than26scores. Many patients lost their scores in the visuospatial and executive function (22%patients) and delayed recall ability (23%patients). Few patients lost scores in short-term memory, attention, linguistic capacity and abstract memory. The results showed that the patients had cognition impairment, especially in visuospatial, executive function and delayed recall ability.3. The results of ADL showed that71percent of patients got20scores, the other29percent of patients got more than20scores. Among those29percent patients,12patients (6percent) had more than26scores. The functions of traveling by bus oneself, cooking oneself, shopping and financial management took great part in the scores counting. The results showed that the patients had ADL decrease, especially in traveling by bus by self, cooking by self, shopping and financial management.4. Statistic results showed there was a significant negative correlation between ADL and MMSE (r=-0.40, P<0.01), and there was significant negative correlation between ADL and MoCA (r=-0.32, P<0.01), which suggested that the worse the cognitive function, the worse the living activity levels.5. Taking ADL as dependent variable, each item of MMSE as the independent variable, the regression analysis showed that the orientation ability, attention and calculation ability, recall ability effected on ADL greatly (β=-0.17～-0.23,P<0.01, P <0.05)6. Taking ADL as dependent variable, each item of MoCA as the independent variable, the regression analysis showed that the visuospatial and executive function, attention, delayed memory and orientation ability effected on ADL greatly (β=-0.11～-0.32,P<0.01,P<0.05)Conclusions:1. Patients with lacumar infarction had cognitive impairment and living activities decrease.2. There was a significant correlation between the cognition and living activities. Visuospatial and executive function, attention and calculation ability, delayed memory etc influenced on ADL greatly.