Objective To evaluate the cognitive dysfunction and its influential factors in patients with symptomatic and asymptomatic lacunar infarction(LI). Methods Mini-mental state examination (MMSE), MoCA and P300 were carried out among 70 patients with first attack of LI 1 week after, 66 patients with asymptomatic LI and 54 patients for control at first visit. The tests were performed again in the follow-up of half a year and one year. Results (l)The scores of MMSE and MoCA at 1 week, half a year and one year of LI at acute stage were lower than asymptomatic LI(P＜0. 01) and control group(P＜0. 01). Latent periods of P300 at each time point were longer than those in patients with asymptomatic LI (P＜0. 05) and control group (P＜0. 01). (2)The scores of MMSE and MoCA at first visit, half a year of follow-up and one year of follow-up in patients with asymptomatic LI were lower than those in control group(P＜0. 01), and the latent period of P300 was longer than that in control group(P＜0. 01). (3)The scores of MMSE and MoCA at 1 week of LI at acute stage and first visit of asymptomatic LI were higher than those after one year(P＜0. 05). The latent periods of P300 were shorter than those after one year(P＜0. 05). Compared with those half a year after, MMSE and MoCA one year after decreased more and the latent period of P300 prolonged(P＞0. 05). (4) The scores of MoCA in the aspects of visuospatial and executive function, abstract thinking and attention were lower than those in control group (P＜0. 01). (5)The score of MoCA in LI patients with multiple foci was lower than that in LI patients with single focus(P＜0. 01). The scores of MoCA in patients with foci in basal ganglia, frontal lobe, temporal lobe and thalamus were lower than those in patients with foci in other parts (P＜0. 01). Conclusion LI (both symptomatic and asymptomatic) is easily accompanied with cognitive dysfunction. The cognitive damage becomes more severe as time prolongs. The common symptoms include damages of visuospatial and executive function, abstract thinking and attention. Patients with multiple foci and with LI in key parts easily suffer from cognitive dysfunction. Thus, it needs to evaluate and prevent early.%目的 评估有症状与无症状性腔隙性脑梗死认知功能障碍及其影响因素.方法 对70例初次发病腔隙性脑梗死患者发病1周、66例无症状腔隙性脑梗死及54例对照者首次就诊时分别进行简易精神状态量表(MMSE)、MoCA、P300测试,并随访半年、1年复测.结果 (1)急性期LI发病1周、半年及1年的MMSE、MoCA评分均低于无症状性LI(P＜0.01)及对照组(P＜0.01),P300潜伏期与无症状性LI(P＜0.05)及对照组(P＜0.01)比较延长.(2)无症状性LI首诊时、半年及1年的MMSE、MoCA评分均低于对照组(P＜O.O1),P300潜伏期与对照组比较均延长(P＜0.01).(3)急性期LI发病1周及无症状LI首诊时MMSE、MoCA评分高于1年后评分(P＜0.05), P300潜伏期与1年后比较缩短(P＜0.05).发病1年较半年MMSE、MoCA评分进一步下降,P300潜伏期延长(P＞ 0.05).(4)MoCA损害以视空间/执行功能、抽象思维、注意力及计算力等方面的评分低于对照组(P＜0.01).(5)腔隙性脑梗死患者多发病灶MoCA评分低于单发病灶(P＜0.01);病灶部位在基底节区、额叶、颞叶、丘脑患者较其他病灶部位MoCA评分低(P＜0.01).结论 腔隙性脑梗死(症状性及无症状性)易合并认知功能障碍,随着时间延长,认知损害进一步加重,多表现为视空间/执行功能、抽象思维、注意力等方面损害,多病灶及关键部位易发生认知损害.故需早期评估,早期预防.
展开▼
