Incidence And Predictive Factors Of Cognitive Impairmrnt After Acute Ischemic Stroke

Purpose:Post-stroke cognitive impairment is common in acute ischemic stroke.Studies have shown that in different countries,different races,the incidence of post-stroke cognitive impairment with different diagnostic criteria varies widely,about 20.0% to 80.0%.According to different degrees of decline of cognitive function,PSCI is divided into PSCIND and PSD.Risk factors of PSCI include demographics,vascular,clinical and imaging,blood biochemistry and other risk factors.As the population ages,the incidence of cognitive impairment after stroke and stroke is increasing year by year,causing serious health,social,and economic burdens.However,there is no effective treatment to restore late-stage post-stroke cognitive function,to delay or block further cognitive decline.Thus,the early intervention is especially important.The purpose of this study is to determine the prevalence and predictive factors of PSCIND and PSD in acute phase(3 weeks)and 3-6 months,to promote the intervention of PSCI in the early-stage,delay or prevents further deterioration of cognitive function and provide a clinical basis for the prevention and treatment of post-stroke cognitive impairment.Materials and Methods:1.572 cases were recruited from among acute ischemic stroke patients consecutively admitted to the hospital from September 2015 to November 2017.292 stroke patients who met the inclusion criteria were screened for the presence of PSCI by CDR score in 3 weeks of onset,CDR=0 was divided into no cognitive impairment(NCI)group,CDR=0.5 was divided into PSCIND group,and CDR ?1 was divided into PSD group.At the same time,demographic data,vascular risk factors,imaging data,and blood biochemical results of the patient were registered.After 3 to 6 months discharge from hospital,the patient's cognitive function status was measured again by the CDR scale.2.Measured data(normal distribution)were statistically described as mean±standard deviation,measurement data(non-normal distribution or variance)were expressed as median(quartiles);count data were expressed in percentages..Firstly,univariate Logistic analysis was performed on the influencing factors of NCI group,PSCIND group,and PSD group,and the reference category was NCI group.The variables with P <0.05 in the univariate analysis were then analyzed by multivariate logistic regression analysis,A probability of P <0.05 was considered statistically significant.Results:A total of five hundred and seventy two cases were consecutively recruited to the study,of which 280 patients were excluded: 20 patients aged <30 years;55 patients with aphasia;70 patients with transient ischemic attack,36 patients with malignant tumors,23 patients with chronic heart or kidney failure,40 patients with incomplete data,36 patients refused to participate Study(see Fig.3).A total of 292 cases were included in the first part of the study(3 weeks).Among them,131 patients(44.9%)were in the NCI group,115 cases(39.4%)were in the PSCIND group,46 cases(15.8%)were in the PSD group,215 cases(73.6%)were male,and 77 cases(26.4%)were female.Their age ranged from 30 to 88 years,and average age was 61.58±11.12 years;104 cases(35.6%)illiterate patients,and 188 cases(64.4%)primary or higher deucation.Three to six months after the onset of stroke,the patient was interviewed and 130 patients were lost.A total of 162 patients were eventually included in the second part of the study(3 to 6 months).Among them,76 cases(46.9%)were in NCI group,65 cases(40.1%)were in PSCIND group,and 21 cases(13.0%)were in PSD group.There were 126 males(77.8%)and 36 females(22.2%);aged 30-87 years old,with means of 60.4±10.60;51cases is(31.5%)were illiterate;111(68.5%)cases were primary or higher education.1.The incidence and influencing factors of PSCIND and PSD at 3 weeks after stroke.115 cases(39.4%)were PSCIND and 46 cases(15.8%)were PSD.Compared with NCI group,univariate analyses revealed that PSCIND was significantly associated with age;EVENS index of cerebral Atrophy(P<0.05).Compared with NCI,univariate analysis found that PSD associated with age;education level;stroke history;infarct size;infarct number;total score of ARWMC;frontal of ARWMC;Occipital and parieta of ARWMC;temporal of ARWMC;ventricular index of brain atrophy;audate head index of cerebral atrophy;basal cistern index of cerebral atrophy;cholesterol,and low density lipoprotein(P <0.05).Multivariate analysis showed that independent factors of PSCIND were EVANS index of brain atrophy(P =0.017,OR=1.500,95% CI 1.075-2.092),infarct size(P =0.021,OR=0.451,95% CI 0.229-0.888),and independent influence factors of PSD were education level(P=0.002,OR=3.767,95 %CI 1.641-28.652),stroke history(P=0.013,OR=0.171,95% CI 0.042-0.690),and lesion size(P=0.002,OR=0.241,95% CI 0.097-0.600).2.Incidence and influencing factors of PSCIND and PSD at 3 to 6 months after stroke.65 cases(40.1%)were PSCIND and 21 cases(13.0%)were PSD.Compared with NCI group,univariate analyses revealed that PSCIND was significantly associated with age;education;hypertension;stroke history(P <0.05).Compared with NCI group,univariate analysis found that PSD associated with age;education;NIHSS;total score of ARWMC;frontal of ARWMC;Occipital and parieta of ARWMC;temporal of ARWMC;ventricular index of brain atrophy;audate head index of cerebral atrophy(P <0.05).Multivariate analysis showed that independent factors of PSCIND were education level(P=0.038,OR=2.333,95% CI 1.047-5.298),and independent influence factors of PSD were age(P=0.010,OR=1.095,95% CI 1.641-28.652),white matter lesion(P=0.037,OR=0.111,95% CI 0.042-0.690),NIHSS(P= 0.103,OR=0.103,95% CI 0.020-0.534).Conclusion:The incidence of PSCIND and PSD were similar between 3 weeks and 3-6 months after acute ischemic stroke.The incidences of PSCIND and PSD were 39.4% and 15.8% respectively in 3 weeks,and the incidences of PSCIND and PSD were 40.1% and 13.0% respectively in 3-6 months.EVANS index of brain atrophy and lesion size were independent factors of PSCIND in 3 weeks after stroke.Education,stroke history and lesion size were independent factors of PSD in 3 weeks after onset of stroke.Education was an independent influencing factor of PSCIND in 3 months after stroke;age,ARWMC of occipital and parietal,NIHSS were independent influencing factors of PSD in 3 months after stroke.