摘要
背景:有研究结果显示运动功能的改善与认知功能密切相关,认知状态好者其运动功能恢复好,早期认知功能的评定可预测运动功能的预后,对患者各项综合能力,社交能力及生活质量的提高均十分有益。目的:观察脑卒中患者认知功能与偏瘫和失语的关系,分析急性脑卒中患者早期认知功能障碍的影响因素。设计:对比观察。单位:泰安市中心医院神经内科和青岛大学医学院附属医院神经内科。对象:选择2002-01/2005-05泰安市中心医院神经内科和青岛大学医学院附属医院神经内科住院的急性脑卒中患者50例,其中男32例,女18例,年龄34～78岁。均符合全国第四次脑血管病会议急性脑卒中的诊断标准,并均经脑CT或MRI证实;且均对评估和检测项目知情同意。其中偏瘫患者44例,男30例,女14例,年龄34～78岁。失语症患者30例,男17例,女13例;年龄34～78岁。非失语症患者20例,男14例,女6例;年龄38～70岁。方法:①采用西方失语成套测验检查法评定是否失语。以失语商<93.8为失语,>93.8为非失语。②采用Fugl-Meyer运动功能评分法评定运动功能。上下肢合计100分,分数越高表示功能越好。③采用洛文斯顿作业治疗用认知成套测验法评定认知功能。内容分为定向力、知觉能力、视运动组织能力、思维运作能力4大项检查,共22个分测验。分数越高表示认知功能越好。功能评定时间均为发病后半个月。样本组间均数行t检验,多组间均数比较用单因素方差分析,偏瘫Fugl-Meyer积分与认知功能评分结果相关性处理采用多元相关分析。主要观察指标:①脑卒中患者认知功能与偏瘫的相关性。②脑卒中患者认知功能与失语的关系。结果:急性脑卒中患者50例均进入结果分析。①脑卒中患者认知功能与偏瘫的相关性:44例偏瘫患者认知功能洛文斯顿作业治疗用认知成套测验法检查内容中的定向力、知觉能力、视运动组织能力积分和认知功能总积分与Fugl-Meyer运动功能评分法积分呈显著正相关(r=0.534,0.598,0.500,0.548,P<0.01),而思维运作能力评分与Fugl-Meyer运动功能评分法积分无明显相关性(r=0.310,P>0.05)。②脑卒中患者认知功能与失语的关系押失语症患者认知功能洛文斯顿作业治疗用认知成套测验法中的定向力、知觉能力、视运动组织能力、思维运作和认知功能总积分分别为(4.60±2.37),(15.10±6.02),(14.00±6.93),(12.33±6.77),(1.83±1.09)分,明显低于非失语症患者眼(7.30±1.08),(23.20±1.11),(24.25±4.08),(24.20±5.43),(3.50±0.76),t=5.44～7.197熏P<0.05演。结论押认知功能障碍较重的急性脑卒中患者偏瘫程度较重;合并失语症的脑卒中患者认知功能显著降低。
BACKGROUND： Some researches suggest that improvement of motor function is closely related to cognitive function. The better the cognitive status is, the better the recovery of motor function is. Early evaluation of cognitive function can predict prognosis of motor function and improve generalized ability, social communication abilities and quality of life （QOL）.
OBJECTIVE： To observe the correlation of cognitive function in hemiplegia and aphasia and analyze the prognostic factor of early cognitive dysfunction in patients with acute stroke.
DESIGN： Contrast study.
SETTING： Department of Neurology, Taian Central Hospital; Department of Neurology, Affiliated Hospital of Medical College of Qingdao University.
PARTICIPANTS： Fifty patients with acute stroke were enrolled from Neurological Department of Taian Central Hospital and Neurological Department of the Affiliated Hospital of Medical College of Qingdao University from January 2002 to May 2005. They were 32 males and 18 females aged 34-78 years. All patients were coincidence with the Diagnostic Criteria of Acute Stroke established by the Fourth National Cerebrovascular Diseases Meeting and diagnosed with CT or MRI. Patients were told about the evaluation in details. Among them, 44 patients had hemiplegia, including 30 males and 14 females aged 34-78 years; 30 had aphasia, including 17 males and 13 females aged 34-78 years; 20 had non-aphasia, including 14 males and 6 females aged 38-70 years.
METHODS： ① Aphasia was tested with Western Aphasia Battery （WAB）. Aphasic quotient of 〈 93.8 was regarded as aphasia; otherwise, it was regarded as non-aphasia. ② Motor function was evaluated with Fugl-Meyer （FMA）. Motor function of upper and lower limbs was scored as 100 in total. The higher the points were, the better the motor function was. ③ Cognitive function was evaluated with Loewenstein Occupational Therapy Cognitive Assessment （LOTCA）, which contained 4 items （orientation, perceptibility, visual-motor organization and thinking ability） and 22 subtests in total. The higher the points were, the better the cognitive function was. Functional evaluation started at half-month treatment onset. Intergroup comparison of their mean value was tested using Student＇s test and one-way analysis of variance.
MAIN OUTCOME MEASURES： ① Correlation between cognitive function and hemiplegia; ② correlation between cognitive function and aphasia.
RESULTS： Fifty patients with acute stroke were all involved in the final analysis. ① Correlation between cognitive function and hemiplegia： Scores of orientation, perception, visual-motor organization and cognitive function of 44 patients with hemiplegia were positive positively correlated with FMA scores of motor function （r=-0.534, 0.598, 0.500, 0.548, P 〈 0.01）; however, scores of thinking ability was not correlated with FMA scores of motor function （r=0.310, P〉0.05）. ② Correlation between cognitive function and aphasia： Scores of orientation, perception, visual-motor organization, thinking operation and cognitive function of patients with aphasia were （4.60±2.37）, （15.10±6.02）, （14.00±6.93）, （12.33±6.77）, （1.83±1.09） points, which were lower than those of patients with non-aphasia （7.30±1.08）, （23.20±1.11）, （24.25±4.08）, （24.20±5.43）, （3.50±0.76） points （t=5.44 to 7.197, P 〈 0.05）.
CONCLUSION： The more severe the cognitive dysfunction is, the more severe the hemiplegia is. Cognitive function in stroke patients with aphasia is significantly reduced.
出处
《中国临床康复》
CSCD
北大核心
2006年第46期181-183,共3页
Chinese Journal of Clinical Rehabilitation
