The Detection Rate And Related Risk Factors Of PSCI-ND?PS-D In Acute Phase Of Cerebral Infarction

Objective: To investigate the detection rate and related risk factors of Post-stroke cognitive impairment no dementia(PSCI-ND),and Post-stroke dementia(PS-D)of inpatients diagnosed with initial cerebral infarction inacute phase.Method:1.Choose 91 inpatients ofthe Department of Neurology at the Second Hospital of Dalian Medical Universityfrom June 2017 to January 2018 into the research,diagnosed with initial cerebral infarction(within 1 week from onset),excluded of Pre-stroke cognitive impairment.Collecting the basic information,biochemical examinations,and imagingexaminations of the patients.Evaluate neuropsychology and other scale for all patients in the group.Evaluate all patients by MoCABeijing version.The patients weredivided into three groups,PS-D group(n=20),PSCI-ND group(n=39)and the normal group(n=32),according to classification and diagnostic criteria of “Expert consensus on post-stroke cognitive impairment management” formulated bypost-stroke cognitive disorders management expert committee of Chinese Apoplexy Association.Analyzing the detection rate and related risk factors of PSCI-ND and PS-D.2.Calculate the detection rate of PSCI,PSCI-ND andPS-D ofthe inpatients in group.3.Compare the differences between the PSCI-ND group and the PS-D group in whole scores,and the scores in each cognitive function of the MoCA scale4.Univariate analyse the factors below between groups of the PS-D group,thePSCI-ND group and the normal group,to make clear whether there are statistical differences between the three groups or not.(1)Basic information: sex,age,years of smoking,years of drinking,years of education,BMI index.(2)Related diseases and cardiac function: hypertension,diabetes,atherosclerosis,atrial fibrillation,blood pressure monitoring,blood glucose monitoring,CHA2DS2-VASc score,cardiac ejection fraction.(3)Biochemical examination: blood coagulation routine,blood lipid,blood uric acid,fasting blood glucose,glycosylated hemoglobin.(4)Imaging characteristics: quantity,location,maximum cross sectional area,volume,Vascular stenosis(responsible arteries or not),leukoaraiosis,asymptomatic lacunar infarction.(5)Related scale score: ESRS score,NIHSS score,HAMD score,NPI score.4.Bring factors with statistical differences of univariate analysis into multivariate unconditional Logistic regression stepwise analysis model,and take eachPSCI(PSCI-ND+PS-D)and PS-D as dependent variable,to find out the possible independent risk factors related to PSCI and PS-D.Results:1.The detection rate and MoCA score analysis:(1)In patients with initial cerebral infarction within 1 week,the detection rate of PSCI is 64.84%?The detection rate of PSCI-ND is 42.86%,and of PS-D is 21.98%.(2)In comparison between PSCI-ND group and PS-D group,the score of MoCA scale is significantly different(P < 0.01).What's more,the score of MoCA scale in PSCI-ND group is significantly higher than that in PS-D group.(3)In competition between PS-D group,PSCI-ND group and normal group,there are significant differences in score of visual space and executive ability,memory,attention,abstraction and orientation(P<0.01).In the segmentation comparison,except that the comparison of PS-D and PSCI-ND group has no statistical difference in the score of memory(P > 0.017),there were statistical differences in the scores of othercognitive domains.(P < 0.017).2.Univariate analysis:(1)The basic information: In the comparison between PS-D group,PSCI-ND group and normal group,there arestatistical differences in age,gender,years of education and years of smoking(P<0.05).In the segmentation comparison,the comparison between PS-D group and normal group shows gender,the years of smoking and years of schooling and age havestatistical differences(P<0.017).The comparison between PSCI-ND group and normal group shows only years of education has significant difference(P < 0.003).(2)The related diseases and cardiac function: Compared with PS-D group,PSCI-ND group and normal group,there are significant differences in hypertension,while cardiac ejection fraction(P <0.01).As for the segmentation comparison,the comparison between PS-D groupand normal group shows that hypertension and cardiac ejection fraction have statistical differences(P<0.017).In comparison between PSCI-ND group and normal group,cardiac ejection fraction has statistical difference(P<0.017).(3)The value of biochemical examination: In the comparison between PS-D group,PSCI-ND group and normal group,there are statistical differences in APTT and uric acid(P<0.05).In the segmentation,in the comparison between PS-D group and normalgroup,there is statistical difference in APTT(P<0.017).In the comparison with PSCI-ND group and normal group,uric acid has statistical difference(P<0.017).(4)The imaging examination:In the comparison with PS-D group,PSCI-ND group and normal group,whether multiple infarction or not,infarct volume,the maximum cross-sectional area,pure subcortical infarction,cortex and subcortical infarcts,head and neck vascular stenosis,stenosis of artery for responsibility are statistically significant(P < 0.01).In the segmentation,in the comparison of PS-D group and the normal group,the infarct volume,the maximum cross-sectional area,pure subcortical infarction,cortex,subcortical infarction,weather multi infarct or not,the responsible artery stenosisare statistically different(P<0.017).In the comparison of PSCI-ND groupand normal group,infarct volume,pure subcortical infarction have statistical differences(P<0.017).(5)Related scale scores: NIHSS score,HAMD score and NPI score are significantly statistically different between PS-D group,PSCI-ND group and normal group(P<0.01).In the segmentation comparison,the comparison of PS-D group with normal group is statistically significant in NIHSS score,HAMD score and NPI score(P<0.003).In the comparison of PSCI-ND group and normal group,there are statistical significances in HAMD score and NPI score(P<0.017).4.Multivariate Logistic regression analysis(1)With PSCI as the dependent variable,the maximum cross-sectional area of infarction,NPI,female,hypertension,pure subcortical infarcts and years of education enter the regression analysis.There are 5 variables having significant differences(p<0.05),including the maximum cross-sectional area of infarction(OR=5.153,95% CI1.267-20.958),NPI score(OR= 13.296,95% CI 3.021-58.522),female(OR=5.253,95% CI 1.280-21.567),pure subcortical infarction(OR=0.047,95% CI 0.008-0.295),years of education(OR=0.191,95% CI 0.05-0.727).(2)With PS-D as the dependent variable,female,NIHSS score,cardiac ejection fraction,HAMD score,APTT enter the regression analysis,in which the female(OR=8.350,95% CI 1.164-59.874),NIHSS score(OR=9.474,95% CI 1.005-89.285),cardiac ejection fraction(OR=0.054,95% confidence interval,HAMD score(0.005-0.590)OR=36.832,95% CI 2.470-549.243)and APTT(OR=0.006,95% CI0-0.152)have statisticaldifference(p<0.05).Conclusion:1.In the patients of initial cerebral infarction within 1 week of onset,the detection rate of PSCI is 64.84%,the detection rate of PSCI-ND is 42.86% and the detection rate of PS-D is 21.98%.PS-D patients have worse cognitive function than PSCI-ND patients.Their cognitive domains impairment are mainly appeared in visual spatial and executive ability,delayed memory,attention,abstraction and orientation.2.In PSCI-ND group,short duration of education,worse cardiac function,high uricacid level,large volume of infarction,high HAMD score,and high NPI score are considered as possible risk factors for PSCI-ND.3.In PS-D group,female,age,less smoking,number of years short of education,scores of disease,hypertension,low APTT value,worse cardiac function,large infarct volume,large maximum lesion cross-sectional area,cortical and cortical subcortical infarcts,multiple infarction,responsibility artery stenosis,high NIHSS score,high HAMD score and high NPI score are considered as the possible risk factors of PS-D.Pure subcortical infarction is considered as a possible protective factor for the pathogenesis of PS-D.4.In the patients of initial cerebral infarction in acute phase,multivariate analysis shows that for patients with PSCI,large area of infarction,high NPI score,female,and short education years may be independent risk factors,while pure subcortical infarction is a possible independent protective factor.For patients with PS-D,female,high NIHSS score,worse cardiac function,high HAMD score,and low APTT value may be independent risk factors.