| Objective1To describe the demographic distribution characteristic and the relevant clinical manifestation of cognitive impairment no dementia (CIND) among the patients with stroke, to offer the data for preventing the occurrence of CIND after stroke.2Investigation and analysis characteristics of cognitive impairment in patients with cognitive impairment no dementia after stroke, to provide the theoretical basis for the implementation of intervention strategies.3According to the population distribution characteristics, influence factors and the characteristics of cognitive impairment of patients with cognitive impairment no dementia after stroke, to explore whether a nurse-led intensive cognitive intervention programme can improve performance of cognitive, activities of daily living and neurological deficits scores of patients’with CIND after stroke.MethodsThe research designd in this study is a randomized controlled trial was conducted at a single hospital. Between April2011to October2012, there were450inpatients after stroke in the stroke unit, sixty-five inpatients with CIND following stroke were randomly divided into two groups:intervention group and control group. Both groups received usual stroke care and early routine training for the physical functions. Patients in the intervention group received an intensive cognitive training by a trained nurse in addition to usual stroke care over a period of12weeks. The control group in waiting lists for future intervention. Mini-mental state examination (MMSE),the montreal cognitive assessment (MoCA), barthel index (BI) and national institute of health stroke scale (NIHSS) were applied between two groups for cognition function, activities of daily living and neurological impairment respectively. The study found no significant difference in scoresof four scales (P>0.05). Intervention for6and12week, MoCA, evaluation scale of BI and NIHSS were applied between two groups again. Each group was30patients successfully follow-up. Chi-square test, repeated measure ANOVA and one-way repeated measures ANOVA were used to analyze the data with SPSS16.0.ResultsThe results of investigation and analysis:1In the study,patients with cognitive impairment no dementia following stroke accounted for15.6%, which with an averge62.68±7.69years of age, averge education level was9.60±2.61years, and that of patients≥60years accounted for66.7%, the male accounted for71.6%. About the cerebral stroke type,49CIND patients were cerebral infarction, accounting for81.7%. The relevant influencing factors of the patients with CIND aftetr stroke as follows:Hypertension was80%, hyperlipidemia was31.7%, diabetes mellitus was31.7%, coronary heart disease was25%, tobacco used was48.33%and alcohol used was25%.2In this study, All participants in a different degrees of cognitive impairment condition but free of dementia at the time of evaluation (mean MMSE score24.53±2.62, mean MoCA score19.27±2.42).Cognitive performance subscores (sub-item score/sub-item total score) were ascending as follows:delayed recall (0.26±0.22)<visuospatial/executive functions(0.51±0.30)<abstract thinking (0.52±0.38)<language (0.56±0.27)<attention/calculation (0.74±0.21)<orientation (0.87±0.22)<naming (0.96±0.13).; Through analyzing the numble of cognitive impairment sub-items,we found that sub-items seven account for3.3%, sub-items six was6.7%, sub-items five was48.3%, sub-items four was26.7%, sub-items three was10%, sub-items two were5%,sub-item one was0. The results of intervention:1The analysis within group:(1)For the intervention group:the cognitive function, activities of daily living at week6and12post-intervention were higher, and there was significant difference between pre and post-intervention(P<0.001); the neurological deficits scores was declined, and there was significant difference between pre and post-intervention by week12(P<0.05), but there is no change between pre and post-intervention by week6(P>0.05).(2)For the control group:although the results showed that the decline of the neurological deficits, and increase of activities of daily living after following up6and 12weeks, there was only statistical significant by week12, and there was no changed by week6(P>0.05); The cognitive function of control group was enhanced after following up6and12weeks, and statistical significant was showed on pre-and post-research.2The analysis between groups:(1)The study found no significant difference in the demography, relevant clinical manifestation and the scores of neuropsychological assessment scales (P>0.05).(2) The patients in the intervention group had a better improve of cognitive function, activities of daily living, and significant increased than patients in the control group by week6and12(P<0.001). The declined of the neurological deficits was observed in both the intervention group and the control group, and there was significant difference between-group (P<0.05) by week12, but there was no significant difference between the groups (P>0.05) by week6.Conclusion1Cognitive impairment no dementia is frequently in stoke patients, most commonly in cerebral infarction, older men and junior middle and high school education level.The main risk factors of post stroke CIND patients which occupy a large proportion,were history of hypertension, diabetes and hyperlipidemia.2Post stroke CIND patients have different damage levels on visuospatial/executive, naming, attention/calculation, language, abstract thinking, delayed recall and orientation. Most of them had combined damage of several cognitive domains, particularly in delayed recall and visuospatial/executive functions, the sub-items naming and orientation damaged not obviously.3The nurse-led intensive cognitive intervention plays a positive role to improve the neurological function, cognitive performance and activities of dalily living of the patients with cognitive impairment no dementia after stroke. |
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