Analysis Of Influencing Factors Related To Cognitive Function In Sequelae Stage Of Adult Japanese Encephalitis

Objective:In order to manage adult Japanses encephalitis(JE)patients more efficiently in the early stage of infection,improve the prognosis of patients,reduce the occurrence of cognitive disorders in the sequela,and improve the JE patient's quality of life,the data of clinical symptoms,cerebrospinal fluid test,Cranial MRI,Electroencephalogram(EEG)and the scores of the simple mental state scale(MMSE)at discharge were collected to explore its relationship with the cognitive function in the sequelae stage of adult JE,study the factors that affect cognitive function in the sequela,strengthen the understanding of adult JE.Methods:A retrospective analysis of 69 cases of JE patients diagnosed in the Second Hospital of Lanzhou University,Gansu Province from June 2017 to October2018,and clinical data of the acute phase were collected.The patients were followed up by telephone at 6 months after discharge,and the cognitive function of the patients was assessed by Telephone Interview for Cognitive status-Modified(TICS-m)(TICS-m ? 33 was divided into non-cognitive impairment group,TICS-m<33 was divided into cognitive impairment group).SPSS 22.0 statistical software was used to process the collected data of clinical symptoms,cerebrospinal fluid test,Cranial MRI,EEG and MMSE score at discharge,and to analyze the risk factors affecting cognitive function in adult JE sequela.Result:1.Among the 69 adult JE patients in this study,there was no significant statistically difference in age,gender,education level,diabetes and hypertension history between the cognitive impairment group and the non-cognitive impairment group(P>0.05).2.Among the 69 adults with JE in this study,patients in the cognitive impairment group were more prone to "decreased consciousness(somnolence,sopor,coma),slowspeech,epilepsy,respiratory failure" than patients in the non-cognitive cognitive impairment group at the acute stage of JE,the difference was statistically significant(P <0.05),indicating that patients with the above symptoms during the acute phase have a higher risk of cognitive impairment during the sequelae;3.Among the 69 adults with JE in this study,the cerebrospinal fluid white blood cell count of patients with cognitive impairment group in the acute stage was higher than patients in the non-cognitive impairment group(P<0.05),indicating that patients with more severe inflammatory infection had worse prognosis and were more likely to be left with cognitive impairment.However,there was no significant difference in CSF protein between the two groups in the acute stage(P>0.05),indicating that CSF protein content in the acute stage did not indicate the cognitive function of JE patients.4.Among the 69 adults with JE in this study,43 patients had abnormal signals in the acute phase of cranial MRI.Compared with patients in the non-cognitive impairment group,patients in the cognitive impairment group were more likely to have "thalamus,brain stem,hippocampus" lesion in the cranial MRI,and the difference was statistically significant(P<0.05),suggesting that patients with the above lesions in the acute stage were more likely to have cognitive impairment during the sequelae.At the same time,the cranial MRI manifestations of JE patients are often not single,and usually involve multiple regions at the same time.The higher the MRI grade,the higher the likelihood of patients with cognitive impairment;5.Among the 69 adults with JE in this study,63 patients showed abnormal changes in EEG,in the patients of cognitive impairment group,moderate and severe abnormalities accounted for a large proportion,while the patients in the non-cognitive impairment group showed normal and mild abnormalities,it suggests that the EEG grading of JE patients has an indicator effect on the cognitive function of prognosis,and the higher the EEG grading,the worse the prognosis of cognitive function;among the 63 patients with abnormal EEG changes,the abnormal waves were mainly characterized by diffuse and/or bilateral non-rhythmic slow activity,a total of 54 cases(85.71%),there was no significant difference between the two groups(P>0.05),it shows that the abnormal waveform of EEG has no obvious meaning for predicting whether the patient has cognitive impairment;6.Among the 69 adult patients with JE in this study,the total MMSE scores and scores of orientations,memory,attention,computational ability,recall ability andlanguage ability were lower in the cognitive impairment group at discharge,with statistically significant differences(P<0.05).7.The results of multivariate Logistic regression analysis showed that: decreased consciousness in the acute stage(somnolence,sopor and coma),slow speech,and abnormal signals in the hippocampal of cranial MRI were risk factors for cognitive impairment in adult JE patients.Conclusion:In adult JE patients,"somnolence,sopor,coma,slow speech" and "cranial MRI hippocampal abnormal signal" during the acute stage of the onset are risk factors for cognitive impairment in patients with sequelae;the higher the MRI grade of the acute phase of JE patients,the more severe the EEG grade,and the lower the MMSE score at discharge,the higher the possibility of remaining cognitive impairment.