RÉSUMÉ
Objective To investigate the changes of cognitive impairment and its correlated factors in patients with first acute cerebral ischemic stroke.Methods Five hundred and sixty-eighty patients,admitted to our hospital from July 2010 to June 2011 and met the diagnostic criteria of first acute cerebral ischemic stroke,were chosen in our study; neuropsychological evaluation was conducted within 1 week of acute cerebral ischemic stroke.The comprehensive neuropsychological evaluation battery included mini-mental state examination (MMSE),Digit span,Mattis dementia scale,Rey complex figure test,stroop test,World Health Organization and University of California-Los Angeles auditory verbal learning test,semantic category verbal fluency test and clock drawing test,which contained tests for memory,attention,executive function,information processing capability,visuospatial and visuo constructive functions.Gender,age,histories of hypertension and smoking,and levels of blood pressure,random blood glucose,fasting blood glucose and 2-hour postprandial blood glucose,cholesterin,triglyceride,low density lipoprotein-C (LDL-C) and high density lipoprotein-C (HDL-C) were noted and the relations between cognitive function and both blood sugar and blood lipid levels were analyzed.Results (1) The abnormal rates of these patients in MMSE,Mattis dementia scale,attention deficit disorder,immediate logical memory disorder,delayed logical memory disorder,instant auditory memory disorder,delayed auditory memory disorder,visual memory disorder,executive function disorder,information processing disorder,and visuospatial and visuo constructive disorder were 78.2％,72.5％,26.5％,56.3％,60.9％,74.6％,98.2％,83.8％,62.7％,4.9％ and 77.7％,respectively.In patients with different blood glucose levels,significant differences were found on scores of MMSE,Mattis dementia scale,attention scale (P＜ 0.05); furthermore,the scores ofMMSE,Mattis dementia scale,attention scale in patients with impaired fasting glucose were obviously lower as compared with those in other groups (P＜0.05).The scale of above cognitive domains showed no significant difference in patients with different types of hyperlipidemias (P＞0.05); the scores of execution ability and visual space structure capability in patients with HDL-C were higher than those in normal density lipoprotein-C and LDL-C (P＜0.05),and the higher level of density lipoprotein-C,the higher scores of visual space structure capability (P＜0.05).Logistic regression analysis found that the total MMSE scores were associated with gender,age,and levels of fasting blood glucose and 2-hour postprandial blood glucose; the independent risk factors of executive function were gender,age and HDL-C level; the ability of memory was correlated with age and HDL-C level.Visuospatial and visuo constructive function was associated with gender,age and mRS scores; the information processing ability was only correlated with HDL-C level.Conclusion In patients with acute cerebral ischemic stroke,the cognitive impairment is extensive and severe,with a prevalence of about 75％,mainly having disorders in memory,executive ability,spatial structure; glucose levels,especially impaired fasting glucose level show most obvious influence in cognitive impairment;HDL-C level helps keep normal cognitive function; age,gender,HDL-C level are the most important factors of cognitive function.
RÉSUMÉ
Objective To investigate the relationship between impaired glucose tolerance(IGT)and carotid atheromatous plague in patients with acute cerebral infarction and analyze the risk factors for plaque formation.Methods The 326 patients hospitalized in our department for acute cerebral infarction were divided into diabetes mellitus(DM)group,IGT group and normal glucose tolerance (NGT)group.The clinical features,biochemical indices and results of Doppler ultrasound examination of the carotid artery were compared between the 3 groups.Results The body mass index(BMI),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)of IGT group were markedly higher than those in NGT group(P＜0.05).Both the IGT and DM group showed significantly increased carotid intimal-medial thickness,plaque detection rate and the incidence of carotid scleratheroma in comparison with the NGT group(P＜0.05).Logistic regressive analysis identified age,TC,LDL-C and 2-h postprandial serum glucose as the independent risk factors for carotid scleratheroma.Conclusion In patients with acute cerebral infarction,those having impaired glucose often show obvious carotid scleratheroma with a severity similar to that in the DM patients.
RÉSUMÉ
Objective To study the relationship between intermediate hyperglycemia and acutece rebrovascular disease. Methods 365 consecutive patients with acute cerebrovascular disease were enrolled. The fasting, non-fasting plasma glucose levels and lipid levels were measured. The non-diabetes patients undergone oral glucose tolerance test (OGTT) 1 week after the onset of the disease. All were classified as having normal glucose tolerance (NGT), intermediate hyperglycemia [IFG(impaired fasting glucose), IGT(impaired glucose tolerance), and co-existence of IFG and IGT] and diabetes mellitus (DM). The rates of the accepted risk factors for atherosclerosis (AS), the severity of the stroke and AS on B scan were compared among the groups. Results The rates of IFG, IGT, and co-existence of IFG and IGT were 1.37%, 24.66%, and 3.01%, respectively. The rate of hypertension was higher in DM subjects (P= 0.007) than in NGT subjects, while the rates in NGT subjects and in DM subjects compared with that in intermediate hyperglycemia subjects were not of statistical significance (P>0.05). And there were no statistical significances in the rates of smoking, drinking and dyslipidemia. Meanwhile no statistical significances were found in the severity of the stroke and the signs of AS detected by duplex scanning (P>0.05). Conclusion Intermediate hyperglycemia is common in the patients with acute cerebrovascular disease. R is important in the pathogenesis of cerebrovascular disease when combined with the other risk factors for AS.