| Part I: Effects of endovascular therapy on neuropsychological and cognitive function in patients with unruptured intracranial aneurysms of intracranial aneurysmsObjective: To explore the effect of endovascular therapy on neuropsychological and cognitive function of patients with unruptured intracranial aneurysm((UIA),as well as the influencing factors of neuropsychological and cognitive function of patients with UIA and their changing trend with time,so as to provide theoretical basis for clinical decision-making.Methods: A total of 156 UIA patients who met the inclusion criteria in the Cerebrovascular Disease Center of Changhai Hospital from February 2019 to December2020 were selected,and the general conditions and clinical data of the patients were collected.Psychological evaluation adopted Hamilton anxiety scale(HAMA),Hamilton Depression scale(HAMD),cognitive function evaluation adopted Montreal Cognitive Assessment scale,digit Span sequence Test,digit symbol conversion,connection Test A,Boston naming Test scale to evaluate the overall cognitive function,memory ability,executive function,attention and language ability.The psychological evaluation was completed by two qualified psychiatrists,and the cognitive evaluation was evaluated by a qualified psychiatrist.Anxiety,depression and cognitive function tests were performed before hospitalization,before operation,6 months after operation and 12 months after operation.After the test,carefully check the scale and check for gaps.The effects of intravascular therapy on the degree and incidence of anxiety and depression and their influencing factors were analyzed by nonparametric coincidence rank test,paired chi-square test and generalized estimation equation.The effects of intravascular therapy on cognitive function and its influencing factors were analyzed by nonparametric coincidence rank test and multivariate logical regression.The variance of repeated measurement data was used to analyze the changing trend of anxiety,depression and cognitive function over time.RESULTS: This study included 156 UIA patients who met the criteria,of which 11(7.05%)lost follow-up,and a total of 145(92.95%)patients were included in the study.1.The effect of endovascular therapy on anxiety and depression and its change trend with time: the degree and incidence of anxiety in patients with UIA after endovascular treatment were significantly lower than those before operation,and the total scores of Hamilton anxiety scale,physical anxiety and mental anxiety after operation were significantly lower than those before operation(all P < 0.05).The incidence of anxiety after operation was significantly lower than that before operation(52.4% vs 359% P <0.05).The degree and incidence of depression in UIA patients after endovascular treatment were significantly lower than those before operation,and the total scores of Hamilton Depression scale,block,sleep disorder,postoperative anxiety somatization,diurnal change,cognitive change and sense of despair were significantly lower than those before operation(P < 0 05).The body weight score had no significant change before and after operation(P > 0 05).The incidence of depression after operation was significantly lower than that before operation(46.9% vs 31.7% P < 0.05).There was a positive correlation between anxiety and depression in UIA patients at admission(r = 0.912).At discharge,6 months and 12 months after operation,the degree and incidence of anxiety and depression decreased significantly with the extension of follow-up time(P < 0.05).2.The influencing factors of anxiety and depression: the economic condition,education level and discovery mode of UIA patients have significant influence on anxiety and depression.The worse the economic condition,the lower the education level,and the more likely the aneurysm patients with headache and other symptoms are to develop anxiety and depression.Age,sex,size of aneurysm,location of aneurysm,number of aneurysm and chronic disease in patients with UIA had no significant effect on anxiety and depression.3.The effect of endovascular therapy on cognitive function and its changing trend with time: there was no significant difference in the scores of Montreal cognitive assessment,digital span order test,digital symbol conversion,connection test An and Boston naming scale in patients with UIA before and after endovascular therapy.There was no significant difference in cognitive function of UIA patients at discharge,6 months and 12 months after treatment.4.The influencing factors of overall cognitive function: the overall cognitive function of UIA patients is affected by education level and age(P < 0.05).The incidence of cognitive impairment in patients with lower education level is higher than that in patients with high education level.The older the patients are,the more likely they are to develop cognitive impairment.The mode of finding aneurysm,aneurysm size,aneurysm location,aneurysm number,sex,chronic disease and economic condition had no significant effect on cognitive function(P > 0.05).Conclusion: Endovascular therapy can significantly reduce the degree and incidence of anxiety and depression in patients with UIA and gradually decrease with time.Endovascular therapy did not impair the overall cognitive function,memory ability,executive function,attention and language ability of patients with UIA and remained stable over time.Part II Effect of cognitive behavioral therapy on neuropsychology in patients with unruptured intracranial aneurysmsObjectives: To explore the effect of cognitive behavioral therapy(CBT)intervention on anxiety and depression in patients with unruptured intracranial aneurysms,and to explore the value of cognitive behavioral therapy intervention model,so as to provide theoretical basis for its clinical application.Methods: Patients who met the inclusion criteria and suffered from depression or anxiety in the Department of Neurosurgery of the Cerebrovascular Disease Center of Changhai Hospital from February 2020 to October 2020 were selected.106 patients were randomly divided into intervention group(n = 53)and routine group(n = 53).The routine group was given general psychological nursing,and the intervention group was given cognitive behavioral therapy under the condition of general nursing.The patients in the two groups were evaluated for anxiety and depression on the day of hospitalization and discharge.The intervention group received cognitive behavioral therapy before and after endovascular treatment,and the routine group received routine psychological nursing.The effects of cognitive behavioral therapy on anxiety,depression and different degrees of anxiety and depression were analyzed by two independent non-parametric samples.Results: A total of 106 patients were included in the intervention group,including 49 patients with anxiety and depression,2 patients with only anxiety and 2 patients with depression,14 patients with obvious anxiety and 11 patients with anxiety.There were 26 cases of possible anxiety,17 cases of depression and 34 cases of depression among 51 patients with depression.In the routine group,there were 48 patients with anxiety and depression,2 patients with only anxiety and 3 patients with depression.Among the 50 patients with anxiety,15 patients definitely had obvious anxiety and 12 patients had anxiety.There were 23 cases of possible anxiety,16 cases of depression and 35 cases of depression among 51 patients with depression.There was no significant difference in age,chronic disease basis,sex,aneurysm discovery mode,aneurysm size,number,location,education level,economic condition and other baseline data between the two groups.1.The effect of cognitive behavioral therapy on anxiety and depression of all patients:there was no significant difference in the total scores of anxiety and depression between the two groups before intervention.After psychological intervention,the total scores of HAMA,somatic anxiety and mental anxiety in the intervention group were significantly lower than those in the general psychological care group(P < 0.05).After psychological intervention,the total score of HAMD,anxiety and somatization,cognitive impairment and sense of despair in the intervention group were significantly lower than those in the routine psychological nursing group(P < 0.05),but there was no significant change in body weight,diurnal change,block and sleep disorder(P > 0.05).2.The effect of cognitive behavioral therapy on different degrees of anxiety :(1)Among the 29 UIA patients with definite and obvious anxiety,the total score of HAMA,physical anxiety score and mental anxiety score of 14 patients after the intervention of cognitive behavioral therapy were not significantly different from those of 15 patients with conventional psychological nursing;(2)Among the 23 patients with definite anxiety group,the total score of HAMA,physical anxiety score and mental anxiety score of 11 patients after cognitive behavioral therapy intervention were significantly different from those of 12 patients with routine psychological nursing(P<0.05);(3)Among the 49 patients with possible anxiety group,the total score of HAMA,physical anxiety score and mental anxiety score of 26 patients after cognitive behavioral therapy intervention were significantly different from those of 23 patients with conventional psychological nursing(P<0.05).3.The effect of cognitive behavioral therapy on different degrees of depression:(1)the influence of different level 33 cases UIA must have depression patients,17 patients after cognitive behavioral therapy intervention besides cognitive impairment,depression HAMD scores and anxiety somatization,changes in body weight,day and night,block,sleep disorder,desperation is no difference between the 16 patients with conventional psychological nursing;(2)Among 69 UIA patients with possible depression,the total score of HAMD,somatization of anxiety,cognitive impairment and sense of despair in 34 patients after cognitive behavioral therapy intervention were significantly lower than those in 35 patients with conventional psychological nursing,while the body weight,day and night change,block and sleep disorder were not significantly changed.Conclusion: The psychological intervention of cognitive behavioral therapy can significantly reduce the degree of anxiety and depression of patients compared with general psychological nursing,and the effect of psychological intervention is obvious for mild to moderate anxiety and depression.for patients with severe anxiety and depression,it is suggested to take combined drug and psychological intervention. |
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