Risk Factors And Neuropsychological Characteristics Of PSCIND And PSD In The Acute Phase Of Cerebral Infarction In Middle-aged And Elderly Patients

Objective:To investigate the risk factors and neuropsychological characteristics of post-stroke cognitive impairment no dementia(PSCIND)and post-stroke dementia(PSD)of inpatients diagnosed with initial cerebral infarction inacute phase in middle-aged and elderly peopleMethod:1.From June 2017 to December 2018,inpatients aged 45-80 years who were admitted to the department of neurology of the second affiliated hospital of Dalian medical university and were first diagnosed with cerebral infarction and within 1 week of onset were collected as research objects,Families or informants of all patients were surveyed using Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE),aiming to exclude patients with Cognitive Decline before stroke,a total of 133 cases were included.According to the diagnostic criteria in the "consensus of Chinese experts in the management of poststroke cognitive impairment" issued by the Chinese stroke society and the expert committee for the management of poststroke cognitive impairment in June 2017,All enrolled patients were screened and evaluated for overall cognitive function by MOCA Beijing version,CDR and ADL,and were divided into the normol group(n=53)?the PSCIND group(n=48)?the PSD group(n=32).All enrolled patients were investigated and recorded their natural conditions,related diseases,some laboratory examinations and imaging data,and evaluated by neuropsychological scales including AVLT,DST,DSMT,BNT Chinese version,CDT,replicative cross pentagon,NPI,HAMD versions 172.Univariate analysis:Normal group,PSCIND group,PSD group in natural condition(age,gender,education level),related diseases(hypertension and grade,type 2 diabetes and course of disease,carotid atherosclerosis),laboratory examination(FPG,2hPG,HbAlc,Hcy,TC,TG,HDL,LDL,plasma D?dimer),imaging examination[infarct location(single cortical infarction,simple subcortical infarction,cortical-subcortical infarction,brainstem and/or cerebellum),leukoaraiosis and degree of looseness],etc.,whether there is statistical difference3.Single factor analysis of statistically significant factors was used as the independent variable to introduce into the ordered multicategory Logistic regression model to analyze the possible independent risk factors affecting the degree and classification of post-stroke cognitive impairment(PSCI)4.The differences of the normal group,PSCIND group and PSD group in the overall cognition,memory,attention and executive ability,language function,visual-spatial ability and other cognitive fields were compared5.The mental behavior symptoms of normal group,PSCIND group and PSD group were comparedResults:Part I1.Results of univariate analysis(1)comparison among the normal group,PSCIND group and PSD group:there were statistically significant differences in the degree of education,type 2 diabetes mellitus,white matter osteoporosis,and the degree of white matter osteoporosis(P<0.05);there were statistically significant differences in age,Hcy,HbAlc,the course of type 2 diabetes mellitus,hypertension,and the location of infarction(P<0.01)(2)Further pairwise comparison of statistically significant factorsComparison between the PSCIND group and normal group:there were statistically significant differences in age and hypertension(P<0.003);Comparison between the PSD group and normal group:there were statistically significant differences in the degree of education,white matter osteoporosis and the degree of white matter osteoporosis(P<0.0167),there were statistically significant differences in age,Hcy,HbAlc,type 2 diabetes,type 2 diabetes course,hypertension,and infarct location(P<0.003);Comparison between the PSCIND group and PSD group:there were statistically significant differences in the course of type 2 diabetes and type 2 diabetes(P<0.0167),there were statistically significant differences in age,HbAlc,and infarct location(P<0.003)2.Multi-factor analysis resultsWith the degree of PSCI classification as the dependent variable,age,education level,Hcy,type 2 diabetes,hypertension,leukoaraiosis,infarct location as independent variables,enter the orderly logistic regression equation analysis,There are 7 variables having significant differences(P<0.05),including age(OR=1.119,95%confidence interval 1.074-1.190),low education level(OR=6.959,95%confidence interval 2.117-24.047),Hcy(OR=1.042,95%confidence interval 1.011-1.073),type 2 diabetes(OR=2.683,95%confidence interval 1.177-6.117),hypertension(OR=4.978,95%confidence interval 1.850-13.383),leukoaraiosis level 0(OR=0.220,95%confidence interval 0.067-0.725),cortical-subcortical infarction(OR=3.955,95%confidence interval 1.114-14.055)were statistically different(P<0.05)Part ?1.Overall cognitive functionComparison among normal group,PSCIND group and PSD group:MOCA score showed a decreasing trend,and there were statistically significant difference(P<0.01);there were statistically significant differences between PSCIND group and normal group,PSD group and normal group,and PSCIND group and PSD group(P<0.003)2.MemoryComparison among the normal group,PSCIND group and PSD group:there were significant statistical differences in scores of immediate recall,short-term delayed recall and long-term delayed recall(P<0.01).Comparison between PSCIND group and normal group:immediate recall,short-term delayed recall,long-term delayed recall scores were significantly different(P<0.003);The scores of immediate recall,short-term delayed recall and long-term delayed recall in the PSD group were significantly different from those in the normal group(P<0.003).Comparison between PSCIND group and PSD group:immediate recall,long-term delayed recall and other scores were significantly different(P<0.003)3.Attention and executive functionComparison among normal group,PSCIND group and PSD group:scores of forward digital span,backwards digit-span and DSMT were significantly different(P<0.01).Comparison between PSCIND group and normal group:DSMT score was significantly different(P<0.003);Comparison between PSD group and normal group scores of forward digital span,backwards digit-span and DSMT were significantly different(P<0.003).Comparison between PSCIND group and PSD group:scores of forward digital span,backwards digit-span and DSMT were significantly different(P<0.003)4.Language functionComparison among normal group,PSCIND group and PSD group:BNT score was significantly different(P<0.01).Comparison between PSD group and normal group,PSCIND group and PSD group:BNT score was significantly different(P<0.003)5.Visual spatial abilityComparison among the normal group,PSCIND group and PSD group:there were significant statistical differences in CDT,replicative cross pentagon scores(P<0.01).Comparison between the PSCIND group and the normal group,and between the PSD group and the normal group:there were significant statistical differences in CDT,replicative cross pentagon scores(P<0.003).Comparison between the PSCIND group and the PSD group:There was a statistically significant difference in the score of the replication pentagon test(P<0.003)6.Mental behavioral symptomsComparison among the normal group,PSCIND group and PSD group:NPI score showed significant statistical difference(P<0.01),while HAMD score showed no statistical difference(P>0.05).PSCIND group and normal group:there was no significant difference in NPI score(P>0.0167).NPI score of PSD group was significantly different from that of normal group(P<0.003).Conclusion:Part ?:1.Age and hypertension may be risk factors for PSCIND.2.Age,education level,Hcy,HbAlc,hypertension,type 2 diabetes,type 2 diabetes course,infarct location,white matter osteoporosis and the degree of white matter osteoporosis may be the risk factors of PSD.3.Older age,lower education level,higher Hcy,cortical-subcortical infarction,hypertension and type 2 diabetes mellitus are independent risk factors affecting PSCI classification,and 0 degree of white matter osteoporosis is the protective factor.Part ?:1.Compared with patients with normal cognition,patients with PSCIND have impairment in cognitive fields such as memory,attention and executive ability,and visuospatial ability,while patients with PSD have impairment in all cognitive fields,and the degree of impairment is more serious.2.Compared with patients with normal cognition,PSCIND patients showed no significant changes in mental behavior symptoms,while PSD patients had more severe mental behavior symptoms.