老年缺血性卒中患者执行功能损害特点及相关影响因素

关键词：执行功能  脑小血管病总负担评分  老年  缺血性脑卒中  受教育年限  汉密尔顿抑郁评分

Keywords:executive function  total cerebral small vessel disease score  elderly  ischemic stroke  education level  Hamilton depression score

摘要：

      摘要 目的：分析老年缺血性卒中患者执行功能（EF）损害的特点，探讨受教育程度（EL）、卒中后抑郁（PSD）及脑小血管病（CSVD）总负担评分与EF的关系。 方法：纳入2021年9月—2022年3月在康复科住院的65—80岁缺血性脑卒中患者34例，与同时期住院的20例65岁以下缺血性卒中患者进行比较，利用Stroop色词测验（SCWT）、数字广度测验（DST）及连线测验（TMT）评估患者EF，分析老年缺血性卒中患者EF损害的特点，并探讨患者EL、HAMD抑郁评分及CSVD总负担评分与EF的关系。 结果：与65岁以下组相比，65岁以上老年卒中患者Stroop B和C耗时较长[Stroop B：62.40±22.75vs41.30（35.51，71.50），Stroop C： 118.94±47.02vs79.50 （59.42，123.25）]、DST顺背与倒背得分较低[DST顺背：7.50±1.29vs8.00（8.00，9.00），DST倒背：3.62±1.05vs4.00 （3.00，5.00）]、TMT-A和B耗时较长[TMT-A：92.29±45.85vs59.49（45.55，86.25），TMT-B：282.32±129.02vs185.00 （128.25， 276.00）]。65岁以上组卒中患者中，Pearson相关分析显示，EL与DST顺背及倒背呈正相关（r=0.356，r=0.401，P＜0.05）；与连线测验A和B耗时呈负相关（r=﹣0.416，r=﹣0.371，P＜0.05）。HAMD抑郁评分与StroopA和B呈正相关（r=0.554，r=0.473，P＜0.01）；与连线测验A和B耗时呈正相关（r=0.520，P＜0.01；r=0.376，P＜0.05）。CSVD总负担评分与EF各项检查均无显著关联。多元线性回归分析显示HAMD抑郁评分与连线测验A耗时呈正相关（B=2.897，95% CI=0.557—5.236，P<0.05）。 结论：老年缺血性卒中患者与较年轻组相比，EF损害更严重。在可能影响EF的几个因素中，EL越高，EF损害相对较轻，提示为认知功能损害的保护因素。另外，抑郁程度越高，部分EF损害越显著。CSVD总负担评分与EF无显著关联。且相对于EL及CSVD负担，抑郁状态对EF影响更大。临床上对于老年缺血性卒中患者，应更加关注其EF障碍，也要及时纠正或改善其抑郁状态，并根据具体情况制定个性化康复治疗方案。

Abstract:

      Abstract Objective：To analyze the characteristics of executive function （EF） impairment in elderly patients with ischemic stroke， and to explore the relationship between EF and the following variables: education level （EL）， post-stroke depression （PSD）， and total cerebral small vessel disease （CSVD） score. Method：A total of 34 ischemic stroke patients aged between 65 and 80 years old who were hospitalized in the rehabilitation department from September 2021 to March 2022 were included. The stroop color word test （SCWT）， digit span test （DST） and trail making test （TMT） were used to evaluate the EF of patients. The characteristics and related factors of EF impairment in elderly patients with ischemic stroke were analyzed. Result：Compared with the group under 65 years old， Stroop B and C time-consuming in stroke patients over 65 years old were longer [Stroop B： 62.40±22.75vs41.30 （35.51，71.50）， Stroop C：118.94±47.02vs79.50 （59.42，123.25））]， DST forward and backward scores were lower [DST forward： 7.50±1.29 vs8.00 （8.00， 9.00）， DST backward：3.62±1.05vs 4.00 （3.00， 5.00）]， TMT-A and B took longer [TMT-A： 92.29±45.85vs59.49（45.55，86.25）， TMT-B： 282.32±129.02vs185.00（128.25， 276.00）]. In patients over 65 years old， Pearson correlation analysis showed that EL was positively correlated with DST forward and backward （r=0.356， r=0.401， P＜0.05）； r=﹣0.416， r=﹣0.371， P<0.05）. The HAMD depression score was positively correlated with StroopA and B （r=0.554， r=0.473， P<0.01）； and was positively correlated with the time-consuming of connection tests A and B （r=0.520， P<0.01； r=0.376， P<0.05）. The total CSVD score was not significantly associated with any of the EF tests. Multiple linear regression analysis showed that the HAMD depression score was positively correlated with the time-consuming of connection test A （B=2.897， 95% CI=0.557—5.236， P<0.05）. Conclusion：Elderly patients with ischemic stroke have more severe EF damage than younger patients. The higher the EL, the relatively mild damage to EF， which suggesting a protective factor for cognitive impairment. In addition， the higher the degree of depression， the more significant the partial EF damage. The total CSVD score was not significantly associated with EF. Compared with EL and the burden of CSVD， post-stroke depression had a greater impact on EF. Clinically，post-stroke depression should be treatment timely for elderly patients with ischemic stroke and more consideration should be given to the EF impairment. Individualized rehabilitation should be developed according to unique conditions of each patient.