Risk Factors Of Cognitive Impairment In Middle-aged And Elderly Patients With Acute Ischemic Stroke

Objective To investigate the risk factors for cognitive impairment in middle-aged and elderly patients with acute ischemic stroke,and to provide some clinical basis for early identification and early intervention of this disease.Methods From December 01,2020 to October 31,2021,148 middle-aged and elderly patients with acute ischemic stroke who were treated in the Department of Neurology,Minda Hospital Affiliated to Hubei Minzu University were collected,and all patients were confirmed to be acute ischemic stroke by brain magnetic resonance imaging.The general information,past disease history,laboratory tests,serum selenium levels,imaging examinations and other related data of all patients were analyzed,and the patients were divided into post-stroke cognitive impairment group（PSCI group,n=68）according to whether the patients had cognitive dysfunction or not.and post-stroke cognitively normal group（non-PSCI group,n=80）,logistic regression was used to analyze the risk factors of PSCI.Results 1.A total of 148 middle-aged and elderly patients with acute ischemic stroke who met the inclusion criteria were collected,68 patients（45.95%）with PSCI and 80 patients（54.05%）without PSCI.2.Univariate analysis of the occurrence of PSCI showed statistically significant differences between the PSCI and non-PSCI groups in age,education,history of previous infarction,homocysteine,Cystatin-C,C-reactive protein,serum selenium level,infarction location,maximum cross-sectional area of the lesion,dominant hemispheric infarction,cerebral white matter degeneration,NIHSS score,and brain atrophy（P<0.05）.3.Multifactorial logistic regression analysis revealed advanced age（OR=1.072,95%CI[1.012-1.136]）,decreased serum selenium levels（OR=0.176,95%CI[0.064-0.479]）,low education（OR=0.163,95%CI[0.042-0.634]）,lesion maximum cross-sectional area increased（OR=1.076,95%CI[1.002-1.154]）,and dominant hemispheric infarction（OR=2.676,95%CI[1.058-6.768]）were risk factors for the development of PSCI（P<0.05）.4.A regression model was developed with the independent risk factors for PSCI in the binary logistic regression equation（age,education,serum selenium level,maximum cross-sectional area of the lesion,and dominant hemispheric infarct）,and the ROC curve was used to analyze the predictive value of this regression model for PSCI.the area under the ROC curve showed that the ability to assess whether a patient would develop a PSCI with this model was 0.881（0.828-0.934）,with an optimal sensitivity of 89.7% and specificity of 72.5%.Conclusions The results of this study showed that advanced age,low education,decreased serum selenium levels,increased maximum cross-sectional area of the lesion,and dominant hemispheric infarction were independent risk factors for the development of PSCI in middle-aged and elderly patients with acute ischemic stroke;regression models with these independent risk factors could predict the development of PSCI.