Risk Factors Of Cognitive Impairment After Acute First-episode Ischemic Stroke

Objective: Post stroke cognitive impairment refers to the decline of cognitive function that occurs after stroke.This study aims to observe the dynamic changes of cognitive level in patients with first-episode ischemic stroke after the clinical event,analyze the related factors of cognitive impairment,and explore the relative influence on various cognitive domains through a more comprehensive neuropsychological evaluation.Methods: A total of 152 patients hospitalized for acute first-episode stroke in Liaoning Provincial People’s Hospital from December 2018 to September 2020 were selected.Montreal cognitive assessment and activity of daily living were performed within 2weeks(at baseline)and 3 months after stroke respectively.After 3 months of followup,25 patients were lost to follow-up,Detailed neuropsychological assessments of immediate memory,long-term delayed memory,attention,executive function,and language and visual space were performed on 127 patients at 3 months after stroke.Meanwhile,Demographic factors,vascular risk factors,and clinical characteristics that may influence cognitive function after acute ischemic stroke were recorded.According to the assessment results at 3 months after stroke,the patients were divided into cognitive impairment group and non-cognitive impairment group.The cognitive impairment group was divided into strategic stroke group(frontal lobe,temporal lobe,basal lobe,thalamus)and non-strategic stroke group(parietal lobe,occipital lobe,brainstem,cerebellum).To observe the dynamic changes of cognitive level of patients with first-episode ischemic stroke,the influence of stroke on global cognition and various cognitive domains,and the correlation between different factors and post stroke cognitive impairment.Results:(1)The incidence of post stroke cognitive impairment in acute stage(baseline)and 3months was 57.2% and 53.5% respectively,MOCA and ADL of the patients were improved at 3 months after stroke,with significant difference(P < 0.05).(2)Prevalence of post stroke cognitive impairment was different in patients with different stroke locations,and the strategic stroke(frontal lobe,temporal lobe,basal lobe and thalamus)had a higher probability of cognitive impairment after stroke,with significant difference(P < 0.05).(3)There were significant differences in global cognition,memory(immediate and long-term delayed memory),language function,attention and executive function between the post stroke cognitive impairment group and the no cognitive impairment group(P < 0.05),while there were no significant differences visual space(P >0.05).There were significant differences in immediate memory,long-term delayed memory and executive function between the strategic stroke post stroke cognitive impairment group and the non-strategic stroke PSCI group(P < 0.05).(4)At 3 months,there were significant differences in education,left side involvement,strategic location,glycosylated hemoglobin,cholesterol,low density lipoprotein and lipoprotein α between the post stroke cognitive impairment group and the no cognitive impairment group(P < 0.05).(5)Strategic location,left side involvement,cholesterol and lipoprotein α were independent risk factors for cognitive impairment 3 months after stroke(P < 0.05).Conclusions: Post stroke cognitive impairment is a common complication of stroke while it can be significantly improved after 3 months;Infarcts in strategic location is more likely to occur post stroke cognitive impairment;Cognitive impairment caused by stroke involved global cognition,memory(immediate and long-term delayed memory),language function,attention,executive function;infarcts in strategic location had significant influence on long-term delayed memory and executive function.strategic stroke,left side involvement,cholesterol,and lipoprotein α were independent risk factors for cognitive impairment after stroke.