| 摘要: |
| 目的 探究非致残性缺血性脑血管事件（NICE）患者早期淡漠与认知和情感障碍的关系。方法 选择2021年6月至2022年12月海军军医大学（第二军医大学）第一附属医院收治的NICE患者244例，男156例、女88例，年龄为（63.1±9.7）岁。根据入院时淡漠评估量表-临床医师版（AES-C）评分分为淡漠组（评分≥ 33分，n=64）和非淡漠组（评分<33分，n=180）。收集患者的人口学资料、血液检测结果和影像学检查结果。根据影像学检查结果，将病因分为短暂性脑缺血发作和轻型卒中，后者再进行Org 10172急性脑卒中治疗试验（TOAST）分型；使用Fazekas量表对白质损伤进行评分。于发病2周内完成匹兹堡睡眠质量指数量表（PSQI）、蒙特利尔认知评估量表（MoCA）、听觉语词学习测验（AVLT）、数字广度测验（DST）、数字符号转换测验（DSST）、数字连线测验（TMT）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）等评估。比较两组患者之间一般资料和各指标的差异，采用多因素logistic回归分析确定早期淡漠的影响因素。结果 NICE患者早期淡漠的发生率为26.2%（64/244）。与非淡漠组相比，淡漠组患者的年龄较大，而BMI和受教育年限较低（均P<0.05）；两组患者的性别、吸烟史、饮酒史、高血压病史差异无统计学意义（均P>0.05）。入院时首次血液检测结果显示两组患者甲状腺激素水平差异无统计学意义，影像学评估结果显示两组患者的病因差异无统计学意义（均P>0.05）；Fazekas量表评分结果提示，淡漠组患者的脑白质损伤程度明显高于非淡漠组（P=0.004）。认知功能检测结果提示，淡漠组患者认知障碍（MoCA总分<26分）发生率高于非淡漠组［46.1%（83/180）vs 59.4%（38/64），P=0.047］。淡漠组患者的语言功能、流畅性、抽象能力、延迟回忆和定向能力明显减退（均P<0.05），两组视空间与执行功能、命名能力、注意力差异无统计学意义（均P>0.05）。此外，淡漠组PSQI、HAMA、HAMD得分高于非淡漠组，且睡眠障碍、焦虑和抑郁的发生率高于非淡漠组（均P<0.05）。多因素logistic回归分析结果显示，HAMD得分、年龄和TMT-A用时为NICE后早期淡漠的危险因素（均P<0.05）。结论 早期淡漠的NICE患者认知障碍发生率更高，且更易出现睡眠障碍、焦虑状态和抑郁状态。HAMD得分、年龄和TMT-A用时为NICE后早期淡漠的危险因素。 |
| 关键词: 非致残性缺血性脑血管事件 淡漠 认知障碍 睡眠障碍 抑郁 焦虑 |
| DOI：10.16781/j.CN31-2187/R.20230347 |
| 投稿时间：2023-06-21修订日期：2023-09-27 |
| 基金项目:国家自然科学基金青年基金（82101563），军事医学创新工程专项（17CXZ002），应用基础研究项目（22BJZ05）. |
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| Correlation between early apathy and cognitive and emotional impairment in patients with non-disabling ischemic cerebrovascular events |
| GAO Xin1,DU Bingying1,GU Zhengsheng1,SUN Xu1,CAI Chen2,BI Xiaoying1* |
(1. Department of Neurology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of VIP Medicine, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the association between cognitive and emotional impairment and early apathy in patients with non-disabling ischemic cerebrovascular events (NICE). Methods A total of 244 NICE patients, 156 males and 88 females, aged (63.1±9.7) years, admitted to The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jun. 2021 to Dec. 2022 were enrolled. Based on the apathy evaluation scale-clinician version (AES-C) scores at admission, patients were categorized into apathy group (score ≥ 33, n=64) and non-apathy group (score<33, n=180). Demographic data, blood test results, and imaging data were collected. According to the imaging examination results, the etiology was divided into transient ischemic attack and mild stroke, and the latter was further classified using the Trial of Org 10172 Acute Stroke Treatment (TOAST). The Fazekas scale was used to evaluate the white matter damage. Within 2 weeks of symptom onset, assessments including the Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment (MoCA), auditory verbal learn test (AVLT), digit span test (DST), digit symbol substitution test (DDST), trail making test (TMT), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were conducted. The differences of the general information and indicators between the 2 groups were compared, and multivariate logistic regression analysis was performed to identify factors influencing apathy. Results The incidence of early apathy in NICE patients was 26.2% (64/244). Compared with the non-apathy group, the patients in the apathy group were older, and had lower body mass index (BMI) and lower level of education (all P<0.05). There were no significant differences in gender, smoking, alcohol consumption, or history of hypertension between the 2 groups (all P>0.05). The results of the first blood test at admission indicated that there was no significant difference in thyroid hormone levels between the 2 groups (P>0.05), and the imaging evaluation results showed that there was no difference in the etiology between the 2 groups (all P>0.05). The results of Fazekas score showed that the degree of white matter injury in the apathy group was significantly higher than that in the non-apathy group (P=0.004). The cognitive function test results indicated that the apathy group had a significantly higher prevalence of cognitive impairment (MoCA total score<26) than that in the non-apathy group (46.1% [83/180] vs 59.4% [38/64], P=0.047). The language function, verbal fluency, abstraction, delayed recall, and orientation of the patients in the apathy group were significantly decreased (all P<0.05), while no significant differences were found in visuospatial/executive function, naming, or attention between the 2 groups (all P>0.05). Furthermore, the apathy group had higher PSQI, HAMA, and HAMD scores compared to the non-apathy group, accompanied by significantly prevalences of sleep disorders, anxiety, and depression (all P<0.05). Multivariate logistic regression analysis revealed that HAMD score, age, and the completion time of TMT-A were risk factors of apathy after NICE (all P<0.05). Conclusion Patients with early apathy have a higher prevalence of cognitive impairment and are more susceptible to sleep disorders, anxiety, and depression. HAMD score, age, and the completion time of TMT-A are risk factors of early apathy after NICE. |
| Key words: non-disabling ischemic cerebrovascular events apathy cognitive impairment sleep disorder depression anxiety |
