摘要
目的探讨卒中后失语患者语言及其他非语言性认知功能障碍的康复特点及影响因素。方法收集自2015年6月至2016年11月在南方医院、南方燕岭医院神经内科住院的急性缺血性脑卒中后失语患者41例，记录基本临床资料、美国国立卫生研究院脑卒中量表评分等。卒中发病1—2周内采用汉语失语检查量表确定为失语症后，使用波士顿诊断失语检查判别失语严重程度，非语言性认知功能评估量表（non-language—based cognitive assessment，NLCA）评估记忆力、视空间能力、逻辑推理能力、注意力及执行功能，并完成卒中后失语患者抑郁问卷（医院版）及日常生活活动能力量表的评定。卒中后3个月再次使用以上量表进行全面评估，共随访失语患者30例。结果（1）失语患者卒中后3个月对比基线，语言评估各项评分均明显提升，差异有统计学意义（P〈0．05）；（2）卒中后3个月NLCA总分[（65．83±13．02）分，（48．00±25．11）分]及记忆力[（17．23±2．49）分，（13．30±5．42）分]、视空间能力[（10．67±2．43）分，（8．07±3．75）分]、逻辑推理能力[（6．53±1．48）分，（4．97±2．43）分]、注意力[（25．57±5．79）分，（17．43±12．33）分]、执行力[（5．77±3．47）分，（4．20±4．23）分]各项均较基线明显改善，差异有统计学意义（P〈0．05）；（3）卒中后3个月失语未完全康复患者NLCA总分[（62．40±14．23）分]及视空间能力[（9．95±2．67）分]、逻辑推理能力[（6．05±1．54）分]两个亚项评分均低于失语完全康复患者[分别为（72．70±6．34）分、（12．10±0．74）分、（7．50±0．71）分]，且日常生活能力[（32．55±12．57）分，（23．40±5．82）分]及抑郁评分[（10．35±7．85）分，（2．40±2．37）分]更高，差异有统计学意义（P〈0．05）；（4）多元回归分析提示基线NLCA评分对失语患者卒中3个月内认知功能改善情况有负向预测作用（β=-0．603，P〈0．01）。结论卒中后失语患者非语言性认知功能的康复特点同语言功能类似，失语未完全康复患者非语言性认知功能及日常生活能力更差，抑郁情绪更严重。基线认知功能是失语患者卒中后3个月认知结局的良好预测因子。
Objective To study the clinical characteristics and potential influencing factors of reha- bilitation of cognition in post-stroke patients with aphasia. Methods Forty-one patients with aphasia after is- chemic stroke, admitted to Nanfang hospital and Nanfang Yanling Hospital from June 2015 to November 2016 were included. Their primary clinical information and NIHSS scores were registered. In acute phase, Aphasia Battery of Chinese and Boston Diagnostic Aphasia Examination was used to evaluate language ability and classify the aphasia type. Non-language-based Cognitive assessment （NLCA） was used to assess patients＇ nonlinguistic cognition. Besides, the assessment of post-stroke depression and dependence degree of daily liv- ing activities were performed. 3 months later, patients were evaluated again. A total of 30 aphasia patients completed the final follow-up. Results （ 1 ） Compared with the baseline in patients with aphasia after stoke, all domains of language ability were significantly improved after 3 months（P〈0.05 ）. （2）Every nonlin- guistie cognitive score was significantly increased within 3 months（ total NLCA score（ 65.83± 13.02 vs 48.00±25.11 ） ,memory（ 17.23±2.49 vs 13.30±.5.42） ,visual spatial ability（ 10.67±2.43 vs 8.07±3.75） ,logical rea- soning ability（ 6.53± 1.48 vs 4.97±2.43 ）, attention（ 25.57±5.79 vs 17.43± 12.33 ）, executive function （ 5.77.± 3.47 vs 4.20±4.23 ） , all P〈0.01 ）. （ 3 ） The NLCA total score （ 62.40± 14.23 vs 72.70±6.34） and scores in visu- al spatial （ 9.95±2.67 vs 12.10±0.74） and abstract reasoning（ 6.05.± 1.54 vs 7.50±0.71 ） of persisting aphasia patients were significantly lower than that of aphasia recovered group（ all P〈0.05）. （4） Multivariate regres- sion showed that initial NLCA score had a negative predictive effect on cognitive function improvement of a- phasia patients 3 months after stroke （ 13=- 0.603, P〈 0.01 ）. Conclusion The rehabilitation of cognitive function in patients with aphasia after stroke is similar to that of language function. Patients with persisting a- phasia may have worse performance on nonlinguistie cognition and ability of daily living, even with more seri- ous depressive emotion. Evaluation of nonlinguistie cognition in post-stroke aphasia patients in aeute phase is necessary and the score seems to be an important predicting factor of 3-month eognition.
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2017年第6期519-523,共5页
Chinese Journal of Behavioral Medicine and Brain Science
基金
南方医科大学南方医院院长基金（2012A002）
关键词
卒中
失语
认知功能
康复
Isehemie stroke
Aphasia
Cognitive function
Rehabilitation
