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: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[(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,P＜0.05].结论: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.
揹景:有研究結果顯示運動功能的改善與認知功能密切相關,認知狀態好者其運動功能恢複好,早期認知功能的評定可預測運動功能的預後,對患者各項綜閤能力,社交能力及生活質量的提高均十分有益.目的:觀察腦卒中患者認知功能與偏癱和失語的關繫,分析急性腦卒中患者早期認知功能障礙的影響因素.設計:對比觀察.單位:泰安市中心醫院神經內科和青島大學醫學院附屬醫院神經內科.對象:選擇2002-01/2005-05泰安市中心醫院神經內科和青島大學醫學院附屬醫院神經內科住院的急性腦卒中患者50例,其中男32例,女18例,年齡34～78歲.均符閤全國第四次腦血管病會議急性腦卒中的診斷標準,併均經腦CT或MRI證實;且均對評估和檢測項目知情同意.其中偏癱患者44例,男30例,女14例,年齡34～78歲.失語癥患者30例,男17例,女13例;年齡34～78歲.非失語癥患者20例,男14例,女6例;年齡38～70歲.方法:①採用西方失語成套測驗檢查法評定是否失語.以失語商＜93.8為失語,＞93.8為非失語.②採用Fugl-Meyer運動功能評分法評定運動功能.上下肢閤計100分,分數越高錶示功能越好.③採用洛文斯頓作業治療用認知成套測驗法評定認知功能.內容分為定嚮力、知覺能力、視運動組織能力、思維運作能力4大項檢查,共22箇分測驗.分數越高錶示認知功能越好.功能評定時間均為髮病後半箇月.樣本組間均數行t檢驗,多組間均數比較用單因素方差分析,偏癱Fugl-Meyer積分與認知功能評分結果相關性處理採用多元相關分析.主要觀察指標:①腦卒中患者認知功能與偏癱的相關性.②腦卒中患者認知功能與失語的關繫.結果:急性腦卒中患者50例均進入結果分析.①腦卒中患者認知功能與偏癱的相關性:44例偏癱患者認知功能洛文斯頓作業治療用認知成套測驗法檢查內容中的定嚮力、知覺能力、視運動組織能力積分和認知功能總積分與Fugl-Meyer運動功能評分法積分呈顯著正相關(r=0.534,0.598,0.500,0.548,P＜0.01),而思維運作能力評分與Fugl-Meyer運動功能評分法積分無明顯相關性(r=0.310,P＞0.05).②腦卒中患者認知功能與失語的關繫:失語癥患者認知功能洛文斯頓作業治療用認知成套測驗法中的定嚮力、知覺能力、視運動組織能力、思維運作和認知功能總積分分彆為(4.60±2.37),(15.10±6.02),(14.00±6.93),(12.33±6.77).(1.83±1.09)分,明顯低于非失語癥患者[(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,P＜0.05].結論:認知功能障礙較重的急性腦卒中患者偏癱程度較重;閤併失語癥的腦卒中患者認知功能顯著降低.
배경:유연구결과현시운동공능적개선여인지공능밀절상관,인지상태호자기운동공능회복호,조기인지공능적평정가예측운동공능적예후,대환자각항종합능력,사교능력급생활질량적제고균십분유익.목적:관찰뇌졸중환자인지공능여편탄화실어적관계,분석급성뇌졸중환자조기인지공능장애적영향인소.설계:대비관찰.단위:태안시중심의원신경내과화청도대학의학원부속의원신경내과.대상:선택2002-01/2005-05태안시중심의원신경내과화청도대학의학원부속의원신경내과주원적급성뇌졸중환자50례,기중남32례,녀18례,년령34～78세.균부합전국제사차뇌혈관병회의급성뇌졸중적진단표준,병균경뇌CT혹MRI증실;차균대평고화검측항목지정동의.기중편탄환자44례,남30례,녀14례,년령34～78세.실어증환자30례,남17례,녀13례;년령34～78세.비실어증환자20례,남14례,녀6례;년령38～70세.방법:①채용서방실어성투측험검사법평정시부실어.이실어상＜93.8위실어,＞93.8위비실어.②채용Fugl-Meyer운동공능평분법평정운동공능.상하지합계100분,분수월고표시공능월호.③채용락문사돈작업치료용인지성투측험법평정인지공능.내용분위정향력、지각능력、시운동조직능력、사유운작능력4대항검사,공22개분측험.분수월고표시인지공능월호.공능평정시간균위발병후반개월.양본조간균수행t검험,다조간균수비교용단인소방차분석,편탄Fugl-Meyer적분여인지공능평분결과상관성처리채용다원상관분석.주요관찰지표:①뇌졸중환자인지공능여편탄적상관성.②뇌졸중환자인지공능여실어적관계.결과:급성뇌졸중환자50례균진입결과분석.①뇌졸중환자인지공능여편탄적상관성:44례편탄환자인지공능락문사돈작업치료용인지성투측험법검사내용중적정향력、지각능력、시운동조직능력적분화인지공능총적분여Fugl-Meyer운동공능평분법적분정현저정상관(r=0.534,0.598,0.500,0.548,P＜0.01),이사유운작능력평분여Fugl-Meyer운동공능평분법적분무명현상관성(r=0.310,P＞0.05).②뇌졸중환자인지공능여실어적관계:실어증환자인지공능락문사돈작업치료용인지성투측험법중적정향력、지각능력、시운동조직능력、사유운작화인지공능총적분분별위(4.60±2.37),(15.10±6.02),(14.00±6.93),(12.33±6.77).(1.83±1.09)분,명현저우비실어증환자[(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,P＜0.05].결론:인지공능장애교중적급성뇌졸중환자편탄정도교중;합병실어증적뇌졸중환자인지공능현저강저.
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 to7.197, 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.
