Study On Related Factors Of Cognitive Impairment In Patients After Acute Ischemic Stroke

Objcetive:Post-stroke cognitive impairment refers to various types and degrees of cognitive impairment within 6 months after stroke,including different degrees of cognitive impairment from non-dementia to dementia after stroke.It is a common complication after stroke and one of the important causes of disability after stroke.But PSCI is often concealed by neurological deficits caused by stroke,such as aphasia,hemiplegia,vertigo and sensory impairment,which not only affects the effective communication between doctors and patients,delays the recovery of stroke patients,but also seriously affects the quality of life of patients,increases the cost of care for family members,and imposes a heavy burden on families and social security system.At present,there is no specific detection and examination method for PSCI.Biomarkers and brain function imaging related to cognitive impairment are expensive,and limited by the level of medical facilities,PSCI can not be widely used for screening.Therefore,this study analyzed the patients with cognitive impairment after acute ischemic stroke in order to understand the related factors of PSCI,so as to identify early PSCI patients in clinic and provide theoretical basis for early clinical intervention of PSCI.Methods:288 patients with acute ischemic stroke hospitalized in neurology department of our hospital from May 2017 to January 2018 were collected.The basic demographic data,past history(hypertension,diabetes mellitus,atrial fibrillation,cerebrovascular disease,etc.)and the laboratory examination(fasting blood sugar,c-LDL,Hcy,CRP etc.)were recorded.All patients were followed up within 3 months with cognitive scale(MMSE scale and ADL scale).According to the score of MMSE scale,the patients were divided into PSCI group and normal cognitive function group.The clinical data of the two groups were compared.SPSS25.0 statistical software was used for statistical analysis to analyze the possible related factors of PSCI.Results:(1)In this study,153 patients had cognitive impairment,and the overall incidence of PSCI was 53.1%.(2)The age,fasting blood glucose,CRP and Hcy levels,NIHSS and ADL scores of PSCI group were higher than those of normal cognitive function group,and the difference was statistically significant.Two tests were used to compare the gender,hypertension history,diabetes history,atrial fibrillation history,cerebral infarction history and the incidence of leukoaraiosis in the two groups.It was found that the incidence of cerebral infarction and leukoaraiosis in the PSCI group was higher than that in the normal cognitive function group,with significant difference(P<0.01).(3)The incidence of PSCI was different in patients with different TOAST types.Among them,the incidence of large-artery atherosclerosis(LAA)was the highest(63.1%);(4)The incidence of cognitive impairment varies with the location of cerebral infarction.The incidence of PSCI was the highest(83.1%)after frontal lobe infarction and the lowest(37.5%)after cerebellar infarction.Two tests were conducted.The results showed that there were significant differences in the infarction sites of frontal lobe,parietal lobe,temporal lobe and occipital lobe between groups(P<0.01).Patients with infarction in these areas were more likely to develop cognitive impairment;(5)There were significant differences in screening univariate analysis(P<0.05).Quantity was an independent variable,and the existence of cognitive impairment was taken as a strain.Multivariate logistic regression analysis was conducted.The model included 8 independent variables:age,blood sugar,Hcy,CRP,NIHSS score,history of cerebral infarction,leukoaraiosis,and infarction in the target observation sites(frontal,parietal,temporal and occipital lobes).Age,fasting blood sugar level,NIHSS score,location of cerebral infarction and past history of cerebral infarction were independent risk factors for PSCI.Conclusion:(l)The incidence of cognitive impairment after acute ischemic stroke is high;(2)The incidence of PSCI was different in different TOAST types and infarction sites,among which LAA type and frontal lobe infarction had the highest incidence.(3)There are many factors influencing cognitive impairment in patients with acute ischemic stroke,including age,fasting blood sugar level,NIHSS score,location of cerebral infarction and previous cerebral infarction.History is an independent risk factor for PSCI.