Current Situation And Countermeasures Study On Vascular Cognitive Impairment After Ischemic Stroke In Chang Sha

Part I Cross-sectional Study on Vascular Cognitive Impairment after Ischemic Stroke in ChangshaObjective:To describe the prevalence rate of vascular cognitive impairment (VCI),vascular cognitive impairment non-dementia (VCIND) and vascular dementia (VD) among the patients with ischemic stroke and to describe the demographic distribution characteristics among the patients with different cognition status after ischemic stroke in Changsha, so as to provide baseline data for further studies on these diseases and to establish VCI library in the same area which can contribute for the government to make the associated health policies in Changsha.Methods:Stratified cluster random sampling method was performed and689patients with both ischemic stroke and his/her age being over40from8communities in Changsha were involved in this study. All subjects had accepted the following neuropsychological assessments:Montreal Cognitive Assessment-Changsha version (MoCA-CS), Mini-Mental State Examination (MMSE), Frontal Assessment Battery-Changsha version (FAB-CS), logical memory from Chinese revised Wechsler Memory Scale (WMS-RC), Activity of Daily Living Scale (ADL), Clinical Dementia Rating (CDR), Functional Activeities (FAQ), Center for Epidemiological Survey (CES-D), National Institute of Health stroke (NIHSS), etc. The criteria of diagnosis were as following:the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards, the NINDS-AIREN criteria. Additionally, Self-designed questionnaires were involved in analysing the demographic characteristics and risk factors of VCI. Results:1. The prevalence rate of VCI among ischemic stroke patients (=40years old) in Changsha was41.8%, which included that of VCI-ND was32.1%and that of VD was9.7%. To male, the prevalence rate of VCI was39.3%, which included that of VCI-ND was29.2%and that of VD was10.1%; To female, the prevalence rate of VCI was45.2%, which included that of VCI-ND was36.1%and that of VD was9.1%.2. The VCI distribution of patients with ischemic stroke was significantly different with age(χ2=40.745, P=0.000), occupations (χ2=24.359, P=0.000), educational level (χ2=238.565, P=0.000), marital status(χ2=9.206, P=0.010), habitation status (χ2=24.359, P=0.000), but not significantly different with gender(χ2=3.686, P=0.158).3. It was statistically significant that The score of ADL (F=65.601, P=0.000), FAQ (F=78.305, P=0.000), CES-D (F=5.306, P=0.006), NIHSS (F=12.340, P=0.000) among the patients with ischemic stroke in cognitive normal group, VCIND group and VD group.Conclusion:1. The prevalence rate of VCI among ischemic stroke patients (=40years old) in Changsha was41.8%, which included that of VCI-ND was32.1%and that of VD was9.7%.2. The VCI distribution of patients with ischemic stroke was significantly different with age, occupations, educational level, marital status, habitation status, but not significantly different with gender. Part Ⅱ Study on the Relevant Influencing Factors of Vascular Cognitive Impairment of the Patients with Ischemic Stroke in ChangshaObjective:To explore the relevant influencing factors of vascular cognitive impairment (VCI) of the patients with ischemic stroke in Changsha as follows:demography, disease history, relevant clinical manifestation of stroke, neuroimaging data, personal living habits, to offer the data for preventing the occurrence of VCI after ischemic stroke.Methods:Stratified cluster random sampling method was performed and689patients with both ischemic stroke and his/her age being over40from8communities in Changsha were involved in this study. All subjects had accepted the following neuropsychological assessments:MoCA-CS, MMSE, FAB-CS, WMS-RC, ADL, CDR, etc. The criteria of diagnosis were as following:the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards, the NINDS-AIREN criteria. All participants were divided into two groups by the diagnosis as follows:the VCI group (including the patients with either VCI-ND or VD) and Control group (including the patients without cognitive imparement). The single factor unconditioned logistic regression analysis was performed to analyze the effects of42different variables from the following aspects (demography, disease history, relevant clinical manifestation of stroke, neuroimaging data, personal living habits) on the occurrence of VCI after ischemic stroke. Collinearity diagnostics was preformed among the variables with statistical significant by the single factor analysis, multi-factor unconditioned logistic regression analysis was done on the variables without any collinearity, to find the independent influencing factors of VCI after ischemic stroke.Results:1. The results of single factor unconditioned logistic regression analysis showed that,16statistical significant variables in the total42 variables could be selected as influencing factors of VCI-ND, but17in that could be selected as influencing factors of VD.2. The results of collinearity diagnostics showed that, there was no collinearity existed in the statistical significant variables of VCI-ND, so was VD.3. The results of multi-factor unconditioned logistic regression analysis showed that, there were12variables entered the regression equation of VCI-ND. Among these variables, advanced age (OR=1.256), high scores of leukoaraiosis in periventricular and deep white matter areas (OR=2.015), existing large vessel lesions (OR=2.088), a large amount of alcohol taking (OR=3.334), lack of hobbies (OR=5.941), long sleeping time (OR=1.880) were risk factors of VCI-ND. While, high educational level (OR=0.388), physical labour (OR=0.478), a small amount of alcohol taking (OR=0.053), regular physical examination (OR=0.436), rich in dietary fiber intake (OR=0.178), drinking milk (OR=0.266) were protective factors of VCI-ND. And there were9variables entered the regression equation of VD. Among them, Living alone (OR=22.235), hyperlipidemia (OR=33.357), TIA (OR=4.624), family history of stroke (OR=14.183), brain atrophy (OR=26.445), eating disorders (OR=18.561), high-fat diet (OR=3.400) were risk factors of VD after ischemic stroke, While, high educational level (OR=0.253), mainly vegetarian diet (OR=0.268) were protective factors of VD after ischemic stroke.Conclusions:1. Age, high scores of leukoaraiosis in periventricular and deep white matter areas, existing large vessel lesions, a large amount of alcohol taking, lack of hobbies, sleep for a long time were risk factors of VCI-ND after ischemic stroke, and high education level, manual labor, a small amount of alcohol taking, regular physical examination, rich in dietary fiber intake, drinking milk were protective factors of VCI-ND after ischemic stroke.2. Living alone, hyperlipidemia, TIA, family history of stroke, brain atrophy, eating disorders, high-fat diet were risk factors of VD after ischemic stroke, and high education level, mainly vegetarian diet were protective factors of VD after ischemic stroke. Part III Investigating the Public Awareness of Vascular Cognitive Impairment in ChangshaObjective:Through investigating the public awareness of vascular cognitive impairment (VCI), to provide the basis for the establishment of the VCI control system.Methods:Stratified cluster random sampling method was performed and689patients with both ischemic stroke and his/her age being over40from8communities in Changsha were involved in this study. All subjects had accepted the following neuropsychological assessments:MoCA-CS, MMSE, FAB-CS, ADL, CDR, etc. The criteria of diagnosis were as following:the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards, the NINDS-AIREN criteria. Self-designed questionnaires were involved in analysing both the awareness of VCI and the attitudes to VCI, investigating subjects are as follows:patients and their caregivers, doctors from communities referred above, doctors from one of complexed hospitals chosen randomly in Changsha. It was described that public awareness, diagnosis of early symptoms, visiting doctors, paying for VCI, and doctors'diagnosis abilities of VCI by T test and one-way ANOVA.Results:1.The public basic awareness of the VCI was Only30.9%, Patient was24.7%, caregivers was29.3%, Grass-roots physicians was61.8%, professional physicians was100.0%; public recognition rate of early symptoms of VCI was22.8%-28.9%, patients was16.3%-22.6%, caregivers was23.3%-31.6%, Grass-roots physicians was38.2%-47.4%professional physicians was67.4%-74.4%;16.2%of the public had discrimination against VCI.2. Awareness score, attitude score and total score of different groups were descending as following:patients>caregivers>physicians, and the differences were statistically significant (P<0.05); Professional significance prompted that physician's recognition of VCI were better than patients and caregivers.3. Awareness score, attitude score and total score of different physicians were descending as following:grass-roots physicians> professional physicians, and the differences were statistically significant (P<0.05); Professional significance prompted that professional physician's recognition and attitude for VCI were better than grass-roots physicians.Conclusion:1. The general public awareness of VCI was not enough, even had a prejudice against VCI, which might be an important reason for poor treatment awareness of patients and carers, diagnosis lag and poor efficacy.2. Medical staff was lack of knowledge on VCI, which might affect its early recognition, timely diagnosis and treatment.3. The difference on awareness of VCI between grass-roots physicians and professional physicians might be an important reason,which caused both hard to realize the two-way referral and to do bad compliance and little feedback between doctors and patients. Part IV Prevention and control measures on Vascular Cognitive Impairment after Ischemic StrokeObjective:According to the population distribution characteristics, influence factors and the findings of public awareness and attitudes of vascular cognitive impairment after ischemic stroke in Changsha City, to explore the VCI control strategies and to provide scientific data for the formulation of health policy.Methods:Through integrating the present research results:the population distribution characteristics, influence factors and the public awareness and attitudes of vascular cognitive impairment after ischemic stroke in Changsha City, we found the control situation of VCI after ischemic stroke in Changsha City and the existence of the following questions:1The prevalence rate of VCI among ischemic stroke patients in Changsha was up to41.8%;2Influencing factors of VCI were divided into risk factors and protective factors, and then by enhancing protective factors and reducing risk factors, VCI can be effective prevention and treatment;3Low public recognition of VCI had serious impacts on the effective prevention and treatment of VCI from multiple aspects. Based on the above situation, we proposed corresponding prevention strategies and established prevention and treatment path for VCI.Countermeasures:1. Strengthen the propaganda, raise public awareness.2. Establish nursing training institutions for VCI patients, to eliminate the negative emotions and concerns of caregivers in the care of VCI patients.3. Improve medical standards of primary health care workers, standardized general practitioner training, and indeed the implementation of two-way referral system.4. Strengthen the VCI professional and technical personnel training, to promote the VCI-related basic research.5. Establishment information monitoring system of VCI and the health file of residents.6. Suggest the government to increase support for efforts and to increase the investment in prevention and control work for VCI.7. Establish prevention path for VCI.