Evaluation Of Cognitive Impairment In Acute Cerebral Infarction With Phlegm And Blood Stasis Obstructing Collaterals And Intervention Study Of Tongnaoyin

Background:stroke is not only listed as the top of the disease that decreasing longevity,but also the leading cause of death and disability in China.Cognitive dysfunction is common following stroke,which destroys patients’ life and increases the mortality,however,evaluation of cognition is not performed routinely in patients with acute stroke.Studies have shown that more than half of the stroke patients will experience cognitive impairment even if the modified Rankin Scale score(mRS)indicates good neurological recovery.The importance of regular assessment of cognitive function in the stroke care has been increasingly emphasized in recent years.Meanwhile,we should attach importance to the high heterogeneity of the post-stroke cognitive impairment(PSCI),and there is a lack of pointed longitudinal clinical research on prevention and treatment.Experiment ⅠObjective:To investigate the risk factors of cognitive dysfunction in patients with acute cerebral infarction with symptom of phlegm and blood stasis blocking collaterals,so as to provide a basis for effective screening,further prevention and treatment.Methods:the patients with acute ischemic stroke with symptom of phlegm and blood stasis blocking collaterals in the Department of Neurology,Jiangsu Provincial Hospital of Traditional Chinese Medicine from October 2020 to January 2021 were enrolled.Cognitive performance was measured using Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)within 24 hours of admission.A cut-off of less than 26 on the MoCA was deemed to be indicative of cognitive disorder.Clinical characteristics,such as demographic variables,education level,past medical history,blood indexes,neuroimaging characteristics,and stroke severity of the patients with cognitive impairment were compared with those without.Results:(1)93 patients were enrolled,and 45.16%of them had cognitive disorder.Factors independently interrelated to cognitive disorder were education years(OR=0.747,P=0.001),standardized visual score of medial temporal lobe atrophy(MTA-scale score)(OR=3.121,P=0.010),Phlegm syndrome(OR=5.137,P=0.029),Blood stasis syndrome(OR=5.392,P=0.022).Other factors associated with cognitive impairment consist of age,platelet count,parameters of transcranial Doppler(TCD)including pulsatility index(PI)and resistance index(RI)of left middle cerebral artery(L-MCA),peak velocity(Vp)of left carotid(L-CCA)and basilar artery(BA),multiple chronic cerebral infarction,Fazekas scale score,Oxfordshire Community Stroke Project(OCSP)classification.(2)It shows that MoCA score is inversely correlated with age(r=-0.274,P=0.008),Fazekas scale score(r=-0.249,P=0.016),MTA-scale score(r=-0.460,P=0.000),and positively correlated with education level(r=0.315,P=0.002),platelet count(r=0.234,P=0.024)and Vp of L-CCA(r=0.371,P=0.010).Conclusion:Early cognitive impairment after ischemic stroke is associated with age,education level,platelet count,PI and RI of L-MCA,Vp of L-CCA and BA,multiple chronic cerebral infarction,MTA-scale score,OCSP,Phlegm syndrome and Blood stasis syndrome.Furthermore,education level,MTA-scale score,Phlegm syndrome,Blood stasis syndrome are independent risk factors.Experiment ⅡObjective:To investigate the effect of tongnaoyin on cognitive function and TCM syndrome score of patients with cognitive impairment after acute cerebral infarction with symptom of phlegm and blood stasis blocking collaterals.Methods:40 patients who met the diagnostic criteria were divided into observation group and control group equally according to the random number table method.The control group was given conventional treatment(anti platelet aggregation,lipid regulation and plaque stabilization,Neurotrophic treatment,etc),the observation group was given tongnaoyin 200ml bid for 28 days on the basis of the control group.All patients were evaluated with Mini Mental State Examination(MMSE),Functional Activities Questionnaire(FAQ)and TCM syndrome score scale at day 0 and day 28.Results:(1)MMSE score of the observation group at day 28 was significantly higher than that at day 0(P<0.01).At 28 days,MMSE score of the observation group was also different from that of the control group evidently(P<0.05).FAQ score of the observation group at day 28 was pronounced lower than that at day 0,while there was no statistical difference between the two groups at 28 days.(2)The observation group at day 28 was significant different from that at day 0 in the symptom score of phlegm obstructing orifices and blood stasis respectively(P<0.05),so had the control group.At 28 days,the two syndrome scores of the observation group were obviously lower than those of the control group(P<0.05).the TCM efficacy of the observation group was significant in the symptom score of phlegm obstructing orifices and blood stasis.Conclusion:(1)tongnaoyin can improve the cognitive function and social activity function of patients with cognitive impairment after acute cerebral infarction with symptom of phlegm and blood stasis blocking collaterals.(2)tongnaoyin can increase the TCM efficacy of patients with cognitive impairment after acute cerebral infarction with symptom of phlegm and blood stasis blocking collaterals.