ABSTRACT
Objective To explore the predictive value of short term cognitive assessment in the acute phase of ischemic stroke for 3-6 months after stroke.Methods The demographic data,vascular risk factors,clinical and imaging data of 254 patients with acute ischemic stroke from August 2016 to December 2017 were prospectively registered.The cognitive function was assessed by Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) 3 weeks after stroke onset.Comprehensive cognitive function assessment was performed after 3-6 months of stroke.Multiple factor Logistic regression was used to screen the independent risk factors of cognitive domain and overall cognitive function in 3-6 months.Results Totally 254 consecutive patients with acute ischemic stroke were enrolled.Combined with the inclusion and exclusion criteria,161 patients completed the baseline cognitive assessment,and 138 completed the comprehensive cognitive assessment in 3-6 months after stroke.Logistic regression analysis showed that 3 weeks baseline cognitive status was an independent factor affecting memory (P＜0.05,OR =62.47,95％CI=13.00-205.00),execution (P＜0.05,OR=38.29,95％CI=8.00-170.00),language (P＜0.05,OR=6.46,95％CI=2.31-18.04) and information processing speed (P＜0.05,OR=5.88,95％CI=2.24-15.41) in 3-6 months after stroke.According to the number of impaired cognitive domains,the overall cognitive function was defined.There were 61 cases of no or mild cognitive dysfunction group and 77 cases of moderate or severe cognitive impairment group.Multifactor logistic analysis showed that baseline cognitive status was independent of the overall cognitive function of 3-6 months after apoplexy adjusting for the age and education level (P＜0.05,OR=25.32,95％ CI =7.52-85.39).Conclusion Short cognitive assessment in early apoplexy can predict the short-term functional status of cognitive domains such as memory,execution,language and information processing speed after stroke,and can also predict the overall cognitive level.
ABSTRACT
Objective To investigate the predictive role of cerebral white matter lesions (WML) and subcortical atrophy on cognitive function in patients with acute ischemic stroke (AIS) after 3 months.Methods 233 cases of AIS patients admitted to hospital continuously from September 2016 to March 2018 were enrolled and all of them underwent brain MRI.The degree of WML on FLAIR was evaluated according to the Fazekas grading standard.The linear measurement of subcortical atrophy on T1WI was carried out on the subcortical brain atrophy index,including EVANS ratio (ER),inverse cella media index (iCMI),caudate head index (CHI) and basal cistern index (BCI).Demographic,clinical and imaging data of all patients were also recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were conducted at 3 months after AIS.The patients were divided into normal cognitive function (NCI) group and post stroke cognitive impairment (PSCI) group according to evaluation results of MMSE and MoCA.Multivariate logistic regression analysis was used to screen the independent risk factors of cognitive impairment.Results Univariate analysis showed that age (t=-4.233,P=0.000),sex (x2 =7.501,P=0.006),education (H=21.188,P=0.000),NHISS score (H =5.791,P=0.016),history of atrial fibrillation (x2 =6.484,P=0.011),TIA (x2 =9.015,P=0.003),smoking history (x2 =6.943,P=0.008),Fazekas WML score (x2 =27.885,P=0.000),EVANS ratio (H =31.129,P =0.000),inverse cella media index (H =9.434,P =0.002),caudate head index (H=15.148,P=0.000),basal cistern index (t=-1.979,P=0.049) and baseline cognitive function (x2=136.994,P=0.000) were related to cognitive impairment in patients with AIS after 3 months (P＜0.05).Multivariate logistic regression analysis showed that WML score (OR=3.416,P=0.047,95％CI:1.017-11.482),EVANS ratio (OR=1.245,P=0.038,95％CI:1.012-1.531) and caudate head index (OR =1.187,P=0.040,95 ％ CI:1.008-1.397) were risk factors for cognitive impairment in AIS patients after 3 monfths adjusting for age,education,disease severity and baseline cognitive function.Conclusion WML,EVANS ratio and caudate head index can predict short-term cognitive function in patients with AIS.