房颤相关性卒中患者发生认知障碍的影响因素

Factors Influencing Cognitive Impairment in Patients with Atrial Fibrillation Associated Stroke

摘要: 目的：探讨房颤相关性卒中患者发生认知障碍的影响因素。方法：收集2019年06月至2020年09月在青岛大学附属医院神经内科住院的急性脑梗死患者，根据TOAST病因分型筛选出与房颤病因相关的心源性栓塞型患者，在发病7天后应用蒙特利尔评估量表(Montreal cognitive assessment scale, MoCA)对入组患者进行认知功能评估，分为有认知障碍组(MoCA < 26分)及无认知障碍组(MoCA ≥ 26分)。收集患者的人口统计学因素及血管危险因素，并根据磁共振的影像学表现进行脑梗死部位统计。完成评估并资料完整的患者共126例，均征得患者及家属知情同意。结果：1) 对有无认知障碍2组进行统计学分析，结果显示认知障碍与年龄、额叶和丘脑梗死有关，差异有统计学意义(P < 0.05)。2) 对认知功能子项进行比较，结果显示房颤相关性卒中患者的认知域损害主要为视空间和执行能力、命名、语言、延迟回忆及定向能力，差异有统计学意义(P < 0.05)。结论：年龄、额叶和丘脑梗死可能是房颤相关性卒中患者发生认知功能障碍的重要危险因素，认知域损害主要为视空间和执行能力、命名、语言、延迟回忆及定向能力。

Abstract: Objective: To investigate the influencing factors of cognitive impairment in patients with stroke associated with atrial fibrillation (AF). Methods: Patients with acute cerebral infarction who were hospitalized in the Department of Neurology, Affiliated Hospital of Qingdao University from June 2019 to September 2020 were collected. According to TOAST etiological classification, the patients with cardiogenic embolism related to the etiology of AF were selected. Seven days after the onset of stroke, the Montreal cognitive assessment scale (MoCA) was used to evaluate the cognitive function of the enrolled patients, and they were divided into a cognitive impairment group (MoCA < 26 points) and a cognitive impairment group (MoCA ≥ 26). The demographic factors and vascular risk factors of the patients were collected, and the cerebral infarction sites were counted according to the MRI imaging findings. A total of 126 patients completed the evaluation with complete data. Results: 1) The results showed that cognitive impairment was related to age, frontal lobe and thalamus infarction, with statistically significant differences (P < 0.05). 2) The cognitive function subitems were compared, and the results showed that the cognitive domain damage in patients with stroke associated with AF was mainly visual space and executive ability, naming, linguistic ability, delayed recall and orientation, with statistically significant differences (P < 0.05). Conclusion: Age, frontal lobe and thalamus infarction were important risk factors for cognitive dysfunction in patients with AF related stroke. The cognitive domain impairment in patients with AF related stroke is visual space and executive ability, naming, linguistic ability, delayed recall and orientation.