Cognitive Dysfunction after Acute Lacunar Infarct

血管性失智症(vascular dementia)與血管性認知功能缺損(vascular cognitive impairment)近來由於造成死亡與入住養護機構的風險不斷升高，因此引起了更多的關注。而本研究的目的即著重於發現並釐清在早期陷窩型腦梗塞病人所引起的認知功能障礙。本研究分析了在高雄市立小港醫院神經科自西元2001年11月至2002年10月間診斷為臨床上初次罹患急性陷窩型腦梗塞的患者，並有完整神經心理學測驗之資料者。我們分別以NIHSS scale來評估中風的嚴重度，及以認知能力篩檢工具(CASI)來評估認知功能。這些檢查是分別由神經科醫師與臨床心理師於中風發生後10天內所執行。這項研究發現共23位急性陷窩型腦梗塞的患者中，91.3%（2l人）受測之CASI總分低於應具備的水平分數(cutoff value)。而每一位病人至少都有一項CASI分項測驗分數異常。在所有的分項中，近期記憶是最普遍有缺損，共佔了82.6%。CASI測驗總分異常（低於臨界值）與病人的年齡、教育程度、及施做測驗時與中風發生的間隔時間長短並無明顯相關。這項研究發現認知功能缺損在急性陷窩型腦梗塞病人是很常見的。在所有的分項中，近期記憶是最普遍有缺損的認知功能。而這些認知功能的缺損可能與腦梗塞位置有關；或是因為病人合併有注意力或集中力之缺損，抑或是抽象思考及判斷力之缺損有關。

關鍵字

急性陷窩型腦梗塞；認知能力篩檢工具；認知功能；近期記憶

並列摘要

Vascular dementia and vascular cognitive impairment have attracted more attention recently due to their association with increased risk of death and institutionalization. The purpose of the present study was to detect and identify the characteristics of cognitive impairments during the early stage of lacunar stroke. The subjects consisted of 23 consecutive first-ever acute lacunar infarction patients who were admitted to the Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, from November 2001 to October 2002. The National Institutes of Health Stroke Scale and Cognitive Abilities Screening Instrument (CASI) were used to evaluate stroke severity and cognitive function, and assessments were performed by a neurologist and psychologist, within 10 days of stroke onset. Of the 23 patients, 21 (91.3%) had CASI scores below their respective cutoff values and all patients had cognitive impairment in at least one cognitive domain in CASI. There were no significant correlations between CASI abnormality (below the cutoff value) and patient age, education, or the interval from stroke onset. Recent memory impairment was the most often impaired cognitive domain on CASI (19 patients, 82.6%). There were significant correlations between recent memory and ”attention or concentration” (correlation coefficient, 0.52; p＜0.05), and ”abstraction and judgment” (correlation coefficient, 0.44; p＜0.05). The correlations between recent memory and other domains were not significant. It was concluded that cognitive impairment after acute lacunar infarct is quite common and recent memory is the most often impaired cognitive domain. This may have been caused by the location of the specific lesion as well as by the impairment in ”attention or concentration” or ”abstraction and judgment”.

並列關鍵字

lacunar infarcts ； CASI ； cognitive function ； recent memory

國際替代計量

Cognitive Dysfunction after Acute Lacunar Infarct

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