Clinical Study Of Visual Spatial Dysfunction In Acute Phase In Patients With Ischemic Stroke

Objective:To conduct neuropsychological assessment of patients with ischemic stroke in the acute phase,to explore the value of neuropsychological assessment scale for early diagnosis of post-stroke cognitive impairment,to further analyze the characteristics of visual spatial dysfunction,and to find serum and imaging markers for early prediction of PSCI with VSD.Methods:A total of 221 patients with acute ischemic stroke who met the inclusion and exclusion criteria from April 2018 to June 2019 in the Department of Neurology of the the First Affiliated Hospital of Soochow University were collected,and the demographic information,past history,and admission were recorded.NIHSS score,mRS score and BI index,at the time,NIHSS score and mRS score at discharge,blood routine,liver and kidney function,serum lipids and other serological indicators,and skull MRI+MRA.The cognitive function of patients were evaluated using MMSE and MoCA scales.The depression state of patients was evaluated by HAMD,and the visual space function of patients was assessed by Clock drawing test(CDT).According to the MoCA scoring criteria,patients were divided into the post-stroke cognitive normal group(nonPSCI group)and the post-stroke cognitive impairment group(PSCI group).In addition,according to the criteria of the CDT method,that is,a CDT score less than 3 was considered as for visual spatial dysfunction(VSD),the PSCI group was further divided into PSCI with VSD group and PSCI without VSD group.SPSS 20.0 software package was used for statistical processing.Compare the differences in demographic data,past history,degree of neurological deficit,TOAST etiology,serological indicators,imaging characteristics,and treatment among the three groups of PSCI with VSD,PSCI without VSD,and nonPSCI,Analyze the influencing factors of PSCI with VSD,and compare the ability of MMSE and MoCA visual spatialfunction sub-test items to recognize different visual spatial dysfunction.Results:1.Clinical data of patients with ischemic stroke and the incidence of cognitive impairment in the acute phase:A total of 221 patients with ischemic stroke were included in this study.The average age of the patients was 60.53 ± 12.05 years old,including 150 males(67.9%),71 women(32.1%).There were 117 cases of PSCI in the acute stage,with an incidence rate of 52.9%,including 77 cases of mild cognitive impairment(34.7%),34 cases of moderate cognitive impairment(15.3%),and severe cognitive impairment.Accounted for 6 cases(2.7%).Among them,there is 61.5%with visual spatial dysfunction and 38.5%without visual spatial dysfunction.The good prognosis rate of the PSCI group was 74.4%,which was significantly lower than that of the nonPSCI group(90.4%,p<0.05).The poor prognosis rate of the PSCI group was 25.6%,which was significantly higher than that of the nonPSCI group(9.6%,p<0.05).2.Analysis of influencing factors of post-stroke cognitive impairment with visual spatial dysfunction:A comparison between the PSCI with VSD group,the PSCI without VSD group,and the nonPSCI group found that the three groups had difference in illiteracy,primary and junior high school education,CE stroke,the levels of albumin,prealbumin,Hcyand high-sensitivity CRP.differences in lesions were located in the right,the lesions were located in the frontal,parietal,temporal,and occipital lobe were statistically significant(p<0.05).The differences in neurological deficits at admission were statistically significant(p<0.05).3.The characteristics of impaired cognitive domain of each sub-item and its relationship with visual spatial dysfunction:According to the MMSE scoring,the order of the incidence of cognitive domain impairment from high to low isattention to computing powerdsyfunction,delayrecall dsyfunction,visual spatial dsyfunction,language dsyfunction,directional forcedsyfunction,and immediate memory dsyfunction.The difference between immediate memory dysfunction and language dysfunction between PSCI with VSD and PSCI without VSD was statistically significant(p<0.05).According to the scores of the MoCA sub-items,the order of the incidence of cognitive domain impairment from high to low is delayed recall dysfunction,executive dysfunction,attention dysfunction,visual spatial dysfunction,abstract dysfunction,language dysfunction,orientation dysfunction,the difference between executive dysfunctionbetween PSCI with VSD and PSCI without VSD was statistically significant(p<0.05).Analysis of consistency between pentagon of MMSE subtest and CDT showed that Kappa value was 0.355,p<0.05,the difference was statistically significant.The analysis of the consistency between the replicated cube of the MoCA sub-test and the CDT showed that the Kappa value was 0.669,p<0.05,and the difference was statistically significant.Conclusions:1.The incidence of cognitive dysfunction in patients with ischemic stroke in acute phase is high,which is one of the important factors for the high disability rate of patients with ischemic stroke.2.In TOAST classification,CE type may be related to PSCI with VSD.The levels of prealbumin,albumin,hypersensitive CRP,and Hcy may be related to PSCI with VSD.PSCI is associated with VSD.The lesions at the right and the frontal,parietal,temporal and occipital lobes were associated with PSCI and VSD in the acute phase.3.Visual spatial dysfunction patients are more likely to incorporate immediate memory dysfunction,language dysfunction and executive dysfunction.Both MMSE and MoCA scale sub-items can detect visual spatial dysfunction.The MoCA scale sub-items has better consistency,higher sensitivity and specificity.