| Objectives: To investigate the characteristics of cognitive impairment on patients with acute first-ever lacunar infarction and its evolution. Methods: In a 3A-level teaching hospital, the cognitive performance was prospectively assessed in patients with acute first-ever lacunar infarction and the normal control. The neuropsychological tests included the mini-mental state examination (MMSE) and the scale of Montreal Cognitive Assessment (MoCA). The relationship between the cognitive impairment and lesion location was analyzed, and the risk factors of cognitive impairment were evaluated. The neuropsychological tests were revaluated at 1st month, 3rd month and 6th month. Statistical analyses were performed with the software package of SPSS13.0, with 2-taile P<0.05 considered statistically efficient. Results: 1. 70 patients with acute first-ever lacunar infarction and 60 normal control were selected in the study. Based on the lesion, there were 16 basal ganglia, 14 thalamus, 10 brainstem, 18 periventricular location, 12 corona radiate in 70 patients. 25 LI patients experienced cognitive impairment (36%).2. By logistic regression analysis, the result showed that the onsets of cognitive impairment had correlation with hypertension, diabetes mellitus, hypercholesterolemia and hyperhomocysteinemia (P<0.05).3. Compared with control subject, patients with lesion locations in basal ganglia, thalamus, brainstem, periventricular location, corona radiate had significantly lower scores in visual spatial and executive function, attention, language, abstraction and memory factors(P<0.05); but no significant difference in calculation, naming and orientation factors(P>0.05). Comparisons between the five lesion locations:(1)patients with lesions in basal ganglia, thalamus had significantly low scores in memory compared with other three lesion locations (P<0.05); (2)patient with lesions in basal ganglia, thalamus had also significantly lower scores in language compared with other three lesion locations (P<0.05);(3) patients with lesions in basal had significantly lower scores in visual spatial and executive function compared with other four lesion locations (P<0.05);(4)The patients with lesions in brainstem performed poorer in attention factor score compared with other four lesion locations (P<0.05).4. During the follow-up, there were significantly differences in the scores of attention 1month, 3 month, 6 month after attack compared with 72 hours', which had reached normal level of the control (P<0.05). Significant differences was found between the control and patients with LI after 6 months in scores of visual spatial and executive function, language, abstraction and memory factors(P<0.05), though it showed a favorable turn. It seemed improved poorly after LI.Conclusions: 1. First-ever lacunar infarction usually undergo vascular cognitive impairment. It is closely related to multiple factors, such as hypertension, diabetes mellitus, hypercholesterolemia and hyperhomocysteinemia.2. The location of lesion is considered important factor contributing to cognitive impairment, but there is no significant relationship between cognitive dysfunction and ischemic location volume. The ischemic lesions are found in basal ganglia, thalamus, brainstem, periventricular location as well as corona radiate. The location of lesions in basal ganglia, thalamus can lead to cognitive impairments, especially in language, memory, visual spatial and executive function.3. LI in acute stage can cause cognitive impairment which improve partly after stoke, with an excellent benign prognosis for recovery in attention but poor in memory, visual spatial and executive function. Patients with LI may undergo varying severity of cognitive impairments for 6 moths after they discharge from hospital. There are mild to severe cognitive dysfunction in the first-ever diagnosed LI patients, which need pay attention to and intervene in time. |
