| ?Background?Intracerebral hemorrhage is a disease with high incidence and disability which can cause various cognitive impairment in addition to movement and sensory impairment.At present,there is a lack of comprehensive and objective tools to evaluate cognitive impairment after intracerebral hemorrhage.BCoS was designed for stroke patients by the University of Birmingham in the UK.It provides a comprehensive assessment of cognitive function to stroke patients.The scale has been proven to be a promising tool for screening post-stroke cognitive impairment and identify the type of cognitive impairment in the UK.The reliability and validity of Cantonese and Mandarin version of the BCoS scale have been verified and carried out in relevant clinical research in acute ischemic stroke patients in Guangdong.However,it has not yet been used in hemorrhagic stroke patients.There are also few researches on cognitive impairment of hemorrhagic stroke patients around the world.At the same time,previous researches on lesion-function suggest that cognitive functions such as memory and language function,are mainly related to the dominant hemisphere.The receiving capability of visuospatial information is related to the right hemisphere.There are researches that suggest the lesions in many brain regions,including cerebellum,may lead to cognitive impairment but the results are not uniform.?Objective?1.To explore the comprehensiveness and sensitivity of BCoS in patients with hypertensive intracerebral hemorrhage;2.Attempt to test the clinical features of cognitive impairment in patients with hypertensive intracerebral hemorrhage.?Method?1,Cantonese version BCoS,MoCA,and MMSE measurements were tested on all enrolled patients;2,To analysis the different cognitive domains of hypertensive intracerebral hemorrhage patients in Cantonese version BCoS3,The compare the incidence of cognitive impairment in patients with hypertensive intracerebral hemorrhage at different sites:(1)The incidence of lesions located in the left hemisphere hypertensive intracerebral hemorrhage and in the right hemisphere hypertensive intracerebral hemorrhage were compared;(2)The incidence of lesions located in cerebral hemisphere hemorrhage,cerebellar and / or brainstem hemorrhage were compared.?Results?1,70 patients with hypertensive intracerebral hemorrhage were enrolled with an average age of 66.31 ? 11.31 years.Among the 27 patients,6 patients were unable to complete MMSE or MoCA because of aphasia and 10 patients were unable to complete MMSE or MoCA because the Other reasons..The abnormal rate of cognitive impairment detected by MMSE was 33.34%(18/54),and the abnormal rate of cognitive impairment detected by MoCA was 41.50%(22/53),the abnormal rate of cognitive impairment detected by BCoS was 81.42%(57 /70).Among the 36 patients who were diagnosed to be normal by MMSE,25 patients were found at least one cognitive impairment detected by BCoS;Similarly,among 31 patients who were diagnosed to be normal by MoCA,21 patients were found at least one cognitive impairment detected by BCoS.In MMSE or MoCA normal patients,BCoS revealed the presence of at least one cognitive impairment.Among them,spatial neglect(Apple deletion,tactile fading),language(sentence construction),memory(time and space,story recall and repetition),controlled attention(auditory attention),practical action ability(gesture).2,We evaluated the cognitive impairment in 70 patients with hypertensive intracerebral hemorrhage.The results show that acute hypertensive intracerebral hemorrhage can involve many aspects of cognitive impairment.Among them,language function,memory,executive function and application ability are obviously impaired.The damage rate of more than 30% has the following items.The language(sentence building damage rate is 55.71%,the sentence read damage rate is 40%,the recition damage rate is 40%,pseudo words reading damage rate is 35.71%),memory(recall task damage rate is 52.77%,time and space orientation damage rate is 44.28%),ability to execute(complex graphicscopy damage rate is 47.14%,gesture recognition damage rate is 41.42%,multi step items using damage rate is 35.71%),attention,spatial neglect(apple delete test damage rate is 44.20%,flight test tactile damage rate is 41.40%,visual impaired flight test damage rate is 40%),the control of attention(Bermingham rule conversion damage rate is 44.28%),digital(digital writing damage rate is 40%,digital reading damage rate is 38.57%).3,.Intracerebral hemorrhage in the left hemisphere has a higher rate of language impairment.It also includes attention and spatial neglect,controlled attention,spatial and temporal orientation,digital writing,and executive ability.While the right hemisphere and the left hemisphere there is no difference among egocentric neglect,episodic memory,digital reading,digital computation,insight.(P values were greater than 0.05).4,In the cerebellum and(or)brain stem hemorrhage patients,there were no abnormalities on picture naming,episodic memory,numerical calculation,insight,and other cognitive sub items;However,patients with hemispheric lesions can be a varying degree of cognitive decline in these items;In these two groups of patients,they experienced cognitive decline,including attention,action ability,digital writing,and writing;There was no significant difference in the incidence of cognitive impairment between these two groups(p>0.05)?Conclusions?1.The detection rate of cognitive impairment in intracerebral hemorrhage patients using BCoS was higher than that using MMSE and MoCA.BCo S is more comprehensive in the assessment of cognitive function.2.In acute phase of hypertensive intracerebral hemorrhage patients,there existed many cognitive impairments,including language ability,memory,executive function and application ability.3.Dominant hemisphere is more prone to language disorders.Episodic memory,self centred neglect,digital reading and computational function were associated with bilateral hemispheric lesions.The reason may be that the above functions are achieved by functional connectivity between different parts of the bilateral hemisphere.There is a certain degree of compensation mechanism between different functional sites.Further evidence is needed to enlarge the sample size..4.Bilateral cerebral hemisphere intracerebral hemorrhage occurred in picture naming,episodic memory,digital computation,abnormal insight in the cognitive domain;Bilateral hemispheric intracerebral hemorrhage,the cerebellum and brainstem hemorrhage patients occur attention,executive ability,digital writing,writing impaired cognitive domains;Brainstem and cerebellum may also be involved in attention,executive ability,digital writing.This requires further expansion of sample size to further confirm. |
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