Study On The Symptomatological Classification Of Cognitiveimpairment In Acute Stage Of Ischemic Stroke

Objective:Based on the neuropsychological evaluation and different symptoms in patients with acute ischemic stroke,the paper reclassifies acute ischemic stroke and also observes the differences in epidemiology,imageology and degree of neurological impairment among different types in order to better understand the vascular cognitive impairment,present the appropriate clinical intervention in time and ultimately improve the prognosis.Methods:Two hundred and eight patients with acute ischemic stroke were continuously enrolled prospectively from the Neurology Department of the first affiliated Hospital of Zhejiang University(155 cases)and Jiaxing second hospital(53 cases)from November 2013 to November 2014.The patients were first recorded by age,gender,education life,past medical history,their health stroke scale score by the United States National Hospital,modified Rankin scale classification,laboratory examination,and imageology.Then,the cognitive function was assessed by the Mini-Mental State Examination(MMSE),Alzheimer's Disease Assessment Scale-cognitive subscale(ADAS-cog)and Clinical Dementia Rating Scale(CDRS).According to the diagnostic criteria by National Institute for Neurological Disorders and Stroke and Association Internationale pour la Recherche et I'Enseignement en Neurosciences(NINDS-AIREN)and American Heart Association/American Stroke Association(AHA/ASA),vascular dementia and vascular mild cognitive impairment were divided into four types,namely,"1.probable dementia and vascular mild cognitive impairment","2.possible dementia and vascular mild cognitive impairment","3,dementia and vascular mild cognitive impairment","4.non-dementia and non-mild cognitive impairment".Patients with non-vascular dementia and non-vascular mild cognitive impairment were included in the normal group,and the other patients were in vascular cognitive impairment group.Vascular cognitive impairment group was further divided into memory impairment as the main symptom type,operation impairment as the main symptom type and complex type according to the median score of the memory,language,operation sections of Alzheimer's Disease Assessment Scale-cognitive subscale.SPSS22.0 statistical software was used to analyze and compare the differences of the baseline characteristics,imaging features,and neurological deficits among different groups.Results:There were five types of the acute ischemic stroke in terms of the symptomatological characteristics of cognitive impairment:normal type in 61 patients(29.33%),memory impairment predominated type in 10 patients(4.81%),language impairment predominated type in 35 patients(16.83%),operating impairment predominated type in 14 patients(6.73%)and complex type in 88 patients(42.31%).There was statistically significant differences of each type in age,education year and sex of patients(P<0.05).However,differences among diabetes,hypertension,hyperlipidemia and stroke were statistically insignificant(P>0.05),and neither were those of infarct location and volumes among all these types(P>0.05).In addition,there was no statistical significance in each type between Modified Ranking Scale(mRS)and National Institute of Health Stroke Scale(NIHSS)(P=0.298,P=0.403)on admission(P>0.05).Conclusion:Cognitive impairment exists in most of the patients with acute ischemic stroke.This study reveals that vascular cognitive impairment can be divided into five types according to symptoms,indicating the heterogeneity of vascular cognitive impairment:characteristics of cognitive impairment in different areas vary with age.The older one is,the more damage it may have to memory,attention and visual spatial ability.However,the impact on language is relatively small.In addition,education level may affect the abstraction and generalization ability of language,but there was no significant association with attention and memory function.Furthermore,male is better in the operation ability than women,but more susceptible to damage in memory and language.Lastly,there are no significant differences in imaging signs and neurological deficits among different subtypes.Therefore,further study is needed in the mechanism of the defect of different symptoms to help achieve the nerve rehabilitation.