动脉瘤性蛛网膜下腔出血后认知功能障碍的 维度特异性及其危险因素分析

Domain-Specificity of Cognitive Dysfunction and Its Risk Factor Analysis after Aneurysmal Subarachnoid Hemorrhage

摘要: 目的：本研究旨在探究aSAH患者发病2周时七个核心认知维度(抽象思维、定向力、命名、视空间与执行、延迟回忆、语言、注意与集中)的受损情况及其独立危险因素。方法：回顾性纳入2023年6月至2025年6月成都市第二人民医院神经外科收治的96例aSAH患者。发病2周时采用蒙特利尔认知评估量表(MoCA)和简易精神状态量表(MMSE)评估认知功能，收集人口学、影像学及实验室指标等。通过单因素分析筛选变量(P < 0.05)，再纳入多重线性回归模型。结果：各认知维度受损的危险因素呈现高度特异性。总体认知(MMSE)独立相关因素包括卒中史、丘脑出血、Hunt-Hess分级、GCS评分及合并脑内血肿；MoCA总分受GCS评分、Hunt-Hess分级及改良Fisher分级影响。抽象思维受损与改良Fisher分级III级(负向)及右侧半球实质受累(正向)相关。定向力损害与丘脑出血、左侧半球实质受累及白细胞升高相关。命名功能受GCS评分(保护)、卒中史及脑积水影响。视空间与执行功能受高龄、低教育程度及Hunt-Hess分级影响。语言功能仅与Hunt-Hess分级III级相关。注意与集中功能受改良Fisher分级影响。结论：aSAH后认知功能障碍呈现特异性。临床分级是全局认知的核心影响因素；丘脑出血对定向力损害最重；左侧半球损伤与炎症共同损害定向力；右侧半球损伤与抽象思维提升相关。

Abstract: Objective: This study aims to investigate the impairment patterns across seven core cognitive domains (abstract thinking, orientation, naming, visuospatial/executive function, delayed recall, language, and attention/concentration) and their independent risk factors in patients with aneurysmal subarachnoid hemorrhage (aSAH) at two weeks post-ictus. Methods: A retrospective analysis was conducted on 96 aSAH patients admitted to the Neurosurgery Department of Chengdu Second People’s Hospital from June 2023 to June 2025. Cognitive function was assessed at two weeks using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Demographic, imaging, and laboratory data were collected. Variables were screened using univariate analysis (P < 0.05) and subsequently included in multiple linear regression models. Results: The independent risk factors for cognitive impairment demonstrated high domain-specificity. For global cognition (MMSE), independent factors included a history of stroke, thalamic hemorrhage, Hunt-Hess grade, GCS score, and the presence of intracerebral hematoma. The total MoCA score was influenced by GCS score, Hunt-Hess grade, and modified Fisher grade. Impaired abstract thinking was associated with modified Fisher grade III (negative) and right hemispheric parenchymal involvement (positive). Orientation deficits were linked to thalamic hemorrhage, left hemispheric parenchymal involvement, and elevated white blood cell count. Naming function was affected by GCS score (protective), history of stroke, and hydrocephalus. Visuospatial/executive function was influenced by advanced age, low education level, and Hunt-Hess grade. Language function was solely associated with Hunt-Hess grade III. Attention/concentration function was impacted by the modified Fisher grade. Conclusion: Cognitive dysfunction following aSAH exhibits significant domain-specificity. Clinical grading scales are core factors influencing global cognition. Thalamic hemorrhage severely impairs orientation, while left hemisphere damage and inflammation jointly contribute to orientation deficits. Right hemisphere damage is associated with enhanced abstract thinking performance.