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健康管理在血管性认知障碍患者中的应用
({{custom_author.role_cn}}), {{javascript:window.custom_author_cn_index++;}}Application of health management in the patients with vascular cognitive impairment
({{custom_author.role_en}}), {{javascript:window.custom_author_en_index++;}}目的：探讨健康管理在血管性认知障碍患者（VCI）中的应用效果。方法：选取2018年至2020年在南昌平安好医医学健康体检中心及南昌平安好医综合门诊部进行检查并确诊为VCI的患者82例作为研究对象。其中男性43例，女性39例，年龄65~76岁，文化程度均在初中及以上。随机分为对照组和健康管理组，对照组及健康管理组均按照医嘱给与常规临床药物治疗。健康管理组在常规临床药物治疗的基础上，接受健康管理，其中包括：建立健康管理档案，康复指导，心理干预及定期复查。同时按健康管理时间将健康管理组分为3个月组、6个月组及12个月组。分析各组在入组前和入组后的《简易精神状况检查量表》（MMSE）评分及《蒙特利尔认知评估量表》（MoCA）评分的结果。结果：健康管理3个月、6个月和12个月时，3个健康管理组患者的MMSE和MoCA评分均高于对照组，差异均有统计学意义（均P<0.05）。健康管理12个月时，6个月组和12个月组患者的MMSE和MoCA评分均高于3个月组，差异均有统计学意义（均P<0.05），6个月组与12个月组的MMSE、MoCA评分差异无统计学意义（均P>0.05）。结论：健康管理能改善VCI患者的痴呆程度，提高患者的认知功能，改善患者的生活质量。其中以健康管理6个月为最佳。
Objective: To explore the application effect of health management in the patients with vascular cognitive impairment(VCI). Methods: Eighty-two patients who were examined and diagnosed as VCI in Nanchang Pingan Haoyi Medical Health Examination Center and Nanchang Pingan Haoyi Comprehensive Outpatient Department from 2018 to 2020 were selected as the research objects. Among them, there were 43 males and 39 females, aged 65-76 years, and their education level was the junior middle school or above. They were randomly divided into a control group and a health management group, and the control group and health management group were given routine clinical medication according to the doctor’s advice. The health management group received health management on the basis of routine clinical drug treatment, including the establishment of health management files, rehabilitation guidance, psychological intervention and regular reexamination. At the same time, the health management group was divided into a one-month group, a six-month group and a twelve-month group according to the health management time. The mini mental status examination(MMSE) scores and Montreal cognitive assessment(MoCA) scores of each group before and after enrollment were analyzed.Results: At 3, 6 and 12 months of health management, the MMSE and MoCA scores of the three health management groups were higher than those in the control group, and the difference was statistically significant(P<0.05). At the 12th month of health management, the MMSE and MoCA scores of patients in the 6-month group and the 12-month group were higher than those in the 3-month group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in MMSE and MoCA scores between the 6-month and 12-month groups. Conclusion: Health management can improve the degree of dementia of the patients with VCI, and improve patients’ cognitive function and quality of life. Among them, the health management at 6-month is the best.
血管性认知障碍 / 脑血管病 / 健康管理 / 简易精神状况检查量表 / 蒙特利尔认知评估量表 {{custom_keyword}} /
vascular cognitive impairment / cerebrovascular disease / health management / mini mental status examination scale / Montreal cognitive assessment scale {{custom_keyword}} /
表1 4组患者性别和年龄分布比较 |
| 组别 | 例数 | 男性/[n（%）] | 女性/[n（%）] | 年龄[岁，M（P25，P75）] |
|---|---|---|---|---|
| 对照组 | 19 | 11（57.9） | 8（42.1） | 70（67，72） |
| 健康管理组3个月 | 20 | 9（45.0） | 11（55.0） | 69.5（67.25，72.75） |
| 健康管理组6个月 | 21 | 11（52.4） | 10（47.6） | 69（66，72） |
| 健康管理组12个月 | 22 | 12（54.5） | 10（45.5） | 70.5（67.75，74） |
| P值 | >0.05 | >0.05 | ||
表2 患者治疗前后MMSE和MoCA评分比较 [M（P25，P75），分] |
| 治疗时间 | MMSE | MoCA | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 对照组 | 3个月组 | 6个月组 | 12个月组 | 对照组 | 3个月组 | 6个月组 | 12个月组 | ||
| 入组前 | 14（13，15） | 14（13，15.75） | 15（13，16） | 14.5（13，16） | 15（13，17） | 15（14，17） | 15（14，16） | 15（12.75，16） | |
| 3个月 | 14（13，15） | 17（15，18.75）ab | 14（16， 19）ab | 17.5（16.5，19）ab | 15（13，16） | 17.5（15.25，19）ab | 16（15， 18.5）ab | 17（14.75，18）ab | |
| 6个月 | 14（12，15） | 18（16， 19）ab | 20（19， 21）ab | 19（18，20.25）ab | 14（13，16） | 18（16）19.75）ab | 19（18，21）ab | 19（17， 20）ab | |
| 12个月 | 14（12，16） | 14（17.25，19.75）ab | 21（20， 22）abc | 20（20， 21）abc | 15（12，17） | 18（17， 20）ab | 20（20， 22）abc | 20.5（19.75，21.25）abc | |
| 注：与同组入组前比较，aP<0.05；与对照组入组后同期比较，bP<0.05；与3个月比较，cP<0.05。 |
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The notion of what qualifies as vascular dementia has varied greatly since the first mention of dementia after apoplexy in ancient literature. Current insight points towards a multifactorial cause of cognitive decline at old age, in which vascular components like atherosclerosis, arterio(lo)sclerosis, (micro)infarcts, and amyloid angiopathy play an important role alongside other markers of neurodegeneration. Cerebrovascular disease will be present in most individuals with dementia, but-just like other causes-rarely a cause on its own. The consequent limitations of nosology may be alleviated by addition of a vascular component to the recently introduced amyloid/tau/neurodegeneration etiological classification system for dementia. Meanwhile, risk of dementia is increased about 2-fold after stroke, and the prevention of (recurrent) stroke remains a cornerstone in the prevention of vascular dementia. Similarly, control of cardiovascular risk factors from middle age onwards is likely to have contributed to the reported decline in the age-specific incidence of dementia over the past decades. In conjunction with experimental studies, large-scale observational evidence from imaging, genomics, metabolomics, and alike will continue to improve our understanding of the underlying pathophysiological processes. To prevent ecological fallacies, such etiological studies in patients with dementia are best served by inclusion of subjects regardless of the presumed (single) cause of their disease.
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This study was designed to evaluate functional status at a 1-year follow-up in consecutive first-stroke patients after discharge from rehabilitation hospital and to identify reliable prognostic factors associated with changes in their abilities. Functional evaluation was made of consecutive patients 1 year after discharge to their own homes. Two multiple logistic regressions (forward stepwise) were performed using both improvement and worsening of the Barthel Index score between discharge and follow-up as dependent variables. Independent variables were medical, demographic and social factors. The final sample included 157 out of 172 patients. During the follow-up, 10 patients (5.81%) died because of a new cerebrovascular event, 1 patient died of myocardial infarction, 2 patients had new strokes and 2 fractured their paretic legs. Functionally, 43.3% of the patients maintained the level they achieved during inpatient rehabilitation treatment, 23.6% improved and the remaining 33.1% worsened. Patients with hemineglect and aged >/=65 years had a higher probability of functional worsening (odds ratio, OR = 3.77, 95% confidence interval, CI = 1.42- 10.0 and OR = 3.93, 95% CI = 1. 72-8.95, respectively). Postdischarge rehabilitation (performed for 46.5% of the final sample) was significantly and positively associated with functional improvement (OR = 7.23, 95% CI = 2.89-18. 05), and its absence with functional worsening (OR = 12.32, 95% CI = 4.47-37.01). In conclusion, in nearly half of the cases, functional status was still not stabilized at the time of discharge from the rehabilitation hospital. Postdischarge outpatient treatment was useful for preventing worsening of the functional ability achived during inpatient treatment and increased the possibility of further functional improvement. Age >/=65 years and hemineglect were predictors of functional worsening at follow-up.Copyright 2000 S. Karger AG, Basel
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目的 研究蒙特利尔认知评价量表（MoCA）中文版在轻度认知损害（MCI）诊断筛查中的作用，评价认知功能在疾病进展过程中的临床意义。方法 对年龄、性别、文化程度构成无统计学差异的两组受试者（正常对照组29 例、MCI 组28 例）进行MoCA 和简易智能状态检查量表（MMSE）测试，以其总成绩及各单项成绩作为基线成绩，观察MoCA 和MMSE 在筛查MCI 中的作用，并比较两种量表对筛查轻度认知损害的敏感性、特异性的差异。于初次筛查后12 个月对两组受试者进行再次测试，并与基线成绩进行配对t 检验，比较前后测试成绩间的差异及各单项成绩对预测疾病进展的作用。结果 MoCA和MMSE 对鉴别正常老龄化和轻度认知损害均具有初步筛查作用，MoCA 量表中的视空间执行功能（t =2.151，P = 0.036）、抽象（t = 2.787，P = 0.009）、定向（t = 3.162，P = 0.003）、记忆（t = 4.704，P = 0.000）等单项测试成绩，两组间差异具有统计学意义；以26 分为分界值，MoCA 和MMSE 诊断MCI 的敏感度分别为89.29%和10.71%，特异度为82.76%和100%，MoCA 诊断敏感性显著高于MMSE。MCI 组患者在12 个月后的随访测试中各项成绩均略有下降，其中MoCA 总成绩（t = 6.454，P = 0.000）、视空间执行功能（t =5.610，P = 0.000）、语言（t = 4.954，P = 0.000）测试成绩，复查前后差异有统计学意义。结论 MoCA 对轻度认知损害的诊断敏感性高于MMSE，其中视空间执行功能、抽象、定向、记忆各单项测试成绩具有诊断价值；MoCA 总评分、视空间执行功能、语言等项成绩复查后降低，对轻度认知损害向阿尔茨海默病转化具有提示作用。
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Stroke is a common long-term condition with an increasing incidence as the population ages. This study evaluates temporal changes in the prevalence of cognitive impairment after first-ever stroke stratified by sociodemography, vascular risk factors, and stroke subtypes, up to 15 years after stroke.
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Cognitive disorders after stroke are one of the main causes of disability in daily activities. The main aim of this study was to investigate the frequency of post-stroke dementia, post-stroke mild cognitive impairment (MCI) and post-stroke amnestic MCI at different times after first-ever stroke; 196 patients were included in the study. In addition, cognitive disorders and their clinical course were studied. Frequency of post-stroke dementia was about 10% at all evaluation times; most patients had post-stroke MCI. Of the cognitive functions investigated, mental speed and calculation were most frequently affected. Performance on almost all cognitive tests was improved 6 and 12 months after stroke. Thus, while the frequency of post-stroke dementia is low, the frequency of post-stroke MCI is high, but improvement of cognitive function is possible.Copyright 2004 S. Karger AG, Basel
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表1 4组患者性别和年龄分布比较表2 患者治疗前后MMSE和MoCA评分比较 [M（P25，P75），分]
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