Screening Of Cognitive Impairment And Its Related Factors In Patients Withacute Ischemic Stroke Of TOAST Type Ⅲ

Objective:Numerous studies have evidenced that patients suffering the type Ⅲ ischemic stroke according to thetrial of ORG 10172 in acute stroke treatment(TOAST)criteria is more likely to have cognitive dysfunction,however,which has received little attention in clinical.Moreover,it is usually ignoring the sclerosis of arterial congee appearance for clinical during the classification of the TOAST subtype.Additionally,the relationship between risk factors and post ischemic stroke cognitive dysfunction of the TOAST Ⅲ subtype is still unclear.In the current study,we aim torevealwhether there is risk factor to predict the possibility of cognitive dysfunction in post ischemic stroke patients of TOAST Ⅲsubtype,with the further purpose of helping clinicians to diagnose and manage cognitive dysfunction in post ischemic stroke of TOAST Ⅲ subtype at early phase.Methods:1 Patients with acute ischemic stroke were included from the Department of Nurology,the Sesond Affiliated Hospital of Hebei Medical University ranging from September 1,2014 to October 30,2015.2 The intracranial lesions and atherosclerotic plaque were evaluated by conventional MRI scanning and high resolution MRI.The patients with stroke were selected strictly according to the criteria of TOAST Ⅲ.3 The patients with stroke who fit into the standard of TOAST Ⅲ were evaluated by NIHSS score.On the second day,patients were taken fasting venous blood,which was send to Hebei Medical University Second Hospital Laboratory for blood routine,fasting blood glucose,blood lipids,liver function,renal function,super sensitive C reactive protein(hsCRP),homocysteine(Hcy)detection.After 10 days ± 3 days,patients were evaluated through the Mini Mental State Examination(MMSE)and the Western Aphasia Battery table(WAB)by two fixed neurologists using consistent guidance language.4 According to the Mini Mental State Examination table(MMSE),patients with MMSE≥27 were grouped into PSCI group,and patients with MMSE<27 were divided into non-PSCI group.5 The trial requires all patients to sign informed consent,and to cooperate with the inspection.6 The statistical analysis of data was processed with SPSS 21.Firstly,the related factors of cognitive impairment after stroke were compared betweenn group PSCI and group Non-PSCI,then the variables which have difference between the two groups were elected as independent variable at the level of 0.05 to identify risk factors of cognitive impairment in patients with acute stroke of TOAST Ⅲ type with binary logistic regression analysis.Results:1 Basic cases of clinical data analysis shows that there were 70 patients with acute stroke of TOAST Ⅲ type were screened in this study,and the average age of these patients was 56.41±10.10 years.The maximum age was 74 years old and minimum age was 34 years old.There were 49 male patients(70%),52 patients with hypertensive(74.29%),25 patients with diabetes mellitus(35.71%)and 5 patients with hyperlipidemia(7.14%).2 Post-stroke cognitive impairment screening results:The number of patients who were divided into the group of PSCI(MMSE<27)was 27,and the number of patients who were divided into the group of Non-PSCI(MMSE≥27 分)was 43.The incidence of cognitive dysfunction in patients with acute stroke of TOAST Ⅲ type was 38.57%.3 The comparison between the PSCI group and the Non-PSCI group: There were not statistically significant in age,sex,hypertension,diabetes,hyperlipidemia,smoking,the location of the infarction and the levels of serum homocysteine between thetwo groups.The incidence of aphasia,NIHSS score and hsCRP were higher ingroup PSCI than in group Non-PSCI,the difference was statistically significant(P<0.05).4 Aphasia is an independent risk factor of acute stroke of TOAST Ⅲ type in patients with cognitive dysfunction,OR=5.55,P<0.05.Conclusions:1 The incidence of cognitive dysfunction in patients with acute ischemic stroke of TOAST Ⅲ type was 38.57%,so the clinicians should pay more attention to the patients with stroke of TOAST Ⅲ type on early intervention and the quality of life.2 In this study,we found that aphasia,the severity of stroke and inflammatory response may be related to the occurrence of cognitive dysfunction in patients with acute stroke of TOAST type Ⅲ.3 Aphasia is an independent risk factor of acute stroke of TOAST Ⅲ type which prone to cognitive impairment.As it can predict post-stroke cognitive dysfunction sensitively,we should cause the attention of clinical examination.