| Objective:Acute ischemic stroke(acute ischemic stroke)is suddenly after brain blood supply system lead to brain tissue and necrotic cerebrovascular disease,has the high death and morbidity,can bring heavy economic burden to family and take care of pressure.About 15% of stroke patients in China have dementia before onset,known as pre-stroke dementia(PSD).At the same time,more than 30% of patients with acute ischemic stroke have cognitive impairment after onset,which is called post-stroke cognitive impairment(PSCI).Before this study was to find the cause of stroke dementia(PSD)and the influence factors of poststroke cognitive impairment(PSCI),judgment on especially recent 3 months of short-term prognosis of patients with,to help stroke patients for prevention and rehabilitation,and to further improve the patients life has an important significance after stroke.Methods:Patients with acute ischemic stroke who were hospitalized in our hospital from January 2014 to January 2016 were selected.The IQCODE score was divided into two groups on the day after admission.IQCODE acuity 3.31 group(defined as before the stroke dementia group)and IQCODE < 3.31 group(defined as before the stroke without dementia group)and the onset of 2 weeks using simple intelligent mental state assessment scale(MMSE)patients with cognitive dysfunction in screening,to score lower than the normal standard(MMSE score with a point value between 0 and 30,illiteracy or less 17 points,primary school 20 points or less,secondary school or above 24 points or less),and clinical dementia rating scale(CDR)of 0.5 or higher is defined as a cognitive impairment after stroke group,or for the group without cognitive impairment after stroke,The patients' basic information,imaging diagnostic data and blood examination records were collected,and the improved Rankin scale(m RS)scale was used to measure the prognosis of patients with stroke in recent three months,especially in the last three months.Comparative analysis influence appeared before the stroke patients with dementia(PSD)and cognitive impairment after stroke(PSCI)factors,as well as before the stroke dementia(PSD)and cognitive impairment after stroke(PSCI)affect the prognosis of patients in the near future.Results:A total of 260 patients with acute ischemic stroke were enrolled in our hospital,including 172 male patients and 88 female patients.Hospital the next day,according to former IQCODE divided the patients into stroke dementia group(n = 36)and stroke without dementia group(n = 224)before and 2 weeks after admission according to MMSE and CDR divided the patients into cognitive impairment after stroke group(n = 80)and no cognitive impairment after stroke group(n = 180).(1)The factors of cognitive impairment caused by prestroke dementia(PSD)and the short-term prognosis of stroke patients.There were 36 cases of dementia before the disease.In the basic case analysis,the PSD group was higher than the NPSD group in average age and stroke history.In hematological examination,the PSD group was higher in ldl-c and TC than in NPSD group.In terms of clinical imaging,the proportion of subcortical infarction and the number of old infarcts in the infarcted area of the PSD group were higher than that in the NPSD group.The differences were statistically significant(P<0.05).Multiple factors showed that the independent influence factors of PSD were previous history of stroke(OR3.176,95%CI 1.632-5.963)and high-ldl-c(OR3.390,95%ci 1.601-6.426).Multivariate Logistic regression analysis showed that the independent influence factors of the clinical outcome of ischemic stroke were low education level(OR6.043,95%CI 1.516-22.027)and patients with PSD(OR1.248,95%CI 1.526-7.232).(2)The independent influence factors of poststroke cognitive impairment(PSCI)and the short-term prognosis of stroke patients.Poststroke cognitive impairment occurred in 80 patients after the disease.In the basic case analysis,the PSCI group was higher than the NPSCI group in average age and stroke history.In terms of hematological examination,the ldl-c ratio of PSCI group was higher than that of NPSCI group.In the aspect of clinical influence,the proportion of subcortical infarction in the PSCI group,the number of old infarcts,the value of Hahn and the anterior Angle index were higher than that of the NPSCI group.The differences were statistically significant(P<0.05).Multiple factors showed that the independent influence factors of PSCI were previous stroke history(OR4.031,95%ci 1.710-6.072),high ldl-c(OR3.475,95%ci 1.559-7.509),anterior Angle index(OR8.043,95%ci 3.471-11.940)and low cultural level(OR1.175,95%CI 1.126-1.332).Multivariate Logistic regression analysis showed that the independent influence factors of the clinical outcome of ischemic stroke were lower than education,and patients had PSCI(OR2.015,95%CI 1.428-3.619).(3)Cognitive impairment group(PSCI)and non-cognitive impairment group(NPSCI)cognitive function comparison after stroke.Cognitive impairment after stroke group and without cognitive impairment after stroke LOTCA(cognitive evaluation set scale(Loewenstein Occupational Therapy Congnitive Assessment),according to the results of all items and the total score NPSCI group of all items and the total score were higher than PSCI patients.In particular,the NPSCI group scored significantly higher than the PSCI patients in terms of the visual motor organization and thinking operation requiring higher cognitive abilities.There were significant differences in t test results between PSCI patients and NPSCI groups.Further lines of PSCI group and NPSCI LOTCA test detection,results show that the LOTCA points test,scoring NPSCI group were higher than that of PSCI group of patients,in addition to the object recognition and symbolic action consistency,all have shown significant differences.(4)The correlation between depression status,instrumental daily life ability and early cognitive function of PSCI patients.PSCI patients scored according to the CES-D,divided into depression group and the depression group,80 cases of PSCI in patients with depressive symptoms(21.25%),17 people have not the depressive state of patients with cerebral apoplexy LOTCA total score significantly higher than the depressive state of patients with cerebral apoplexy.(5)Objective factors affecting cognitive function of PSCI patients.There was no significant difference between the scores of gender and hemispheric stroke cognitive function.There was no statistical difference between the left stroke,right stroke or stroke.The influence factors of cognitive impairment after stroke,such as age,stroke size,blood pressure,blood lipid,carotid artery stenosis,etc.,were statistically significant.Conclusion:(1)The history of stroke and high ldl-c are the factors that trigger PSD and PSCI,the frontal lobe atrophy and the cultural level are the factors of PSCI in patients,while PSD and PSCI affect the short-term prognosis of patients.(2)PSCI patients suffer from early cognitive dysfunction,such as difficulty in orientation,confusion in spatial perception,impaired vision,and operational thinking.(3)After acute stroke early cognitive function of patients with cognitive impairment factors is wide,main show is age,stroke lesion size,blood pressure,blood fat,carotid stenosis and other factors,has nothing to do with sex,different hemisphere ischemic stroke.(4)The cognitive function of PSCI patients affects their instrumental daily activities. |
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