中風後認知障礙與顱內血管阻塞之關聯性分析

A Study on the Correlation between Cognitive Impairment and Intracranial Vascular Occlusion for Patients after a Stroke

目的：中風後所造成的腦組織缺損所形成的認知障礙，往往是個案失能的一項重要關鍵。而腦組織缺損的程度，往往正相關於顱內血管阻塞或受損的程度。因此，本研究的目的在於探討中風後患者之認知障礙與顱內血管阻塞程度之關聯性分析。方法：研究之對象為中部地區某區域教學醫院之腦中風就診及有住院紀錄的患者，合格樣本的篩選須同時滿足五項要件，分別為該個案屬於第一次腦中風、腦中風發生後3天內住院、年紀小於80歲、無任何失智症病史並排除重度腦中風之患者（NIHSS>15）。研究方法採資料分析與問卷評估兩者並行之方式，分別進行顱內血管阻塞程度（複合式血管阻塞指標，Composite Intra-Cerebral Stenosis Score， CISS）與認知功能障礙的評估。結果：研究結果顯示，篩選合格的201名樣本中，男性127人(63.2%)、女性74人(36.8%)，年齡的分佈為50至80歲，平均年齡為62.8歲（標準差為11.2歲），其中無顯著性顱內血管阻塞者(CISS=0)148人（佔73.6%）、單一顱內血管阻塞者(CISS=1)21人（佔10.4%）與多重顱內血管阻塞(CISS>=2)32人（佔16.0%）。在認知功能研究上，整體而言中風患者出院後第6個月CASI與MMSE兩項認知功能評估，明顯高於第3個月與初入院治療時(p<0.05)。顯示其病情經由適當之醫療與居家照護後，顱內血管阻塞的狀況可顯著性的達到控制，以致認知功能達到改善。若交叉分析CISS指標發現，顱內初期無顯著性血管阻塞(CISS=0)的這類群組，其認知功能在第6個月與第3個月的改善情況均較初入院時明顯，結果並具有統計上顯著性。結論：在慢性病的關聯性分析上發現，糖尿病患者對於顱內血管阻塞的影響是顯著性的相關，亦即顱內血管阻塞程度越嚴重者，其患有糖尿病的比例越高。同時，中風個案中患有高血壓的比例也是相當高的（佔79.1%）。因此，醫護或長照機構應多加強糖尿病與高血壓這兩類型患者的居家衛教與居家照護服務，以預防患者進一步造成永久性認知功能障礙的情況發生。

Purpose: PCognitive impairment after a stroke resulting in brain defects is a key factor in causing disability. In general, the level of damage to brain tissue is positively related to intracranial vessel occlusion (IVO). Therefore, the purpose of this study was to analyze the relationship between cognition impairment and IVO after a stroke. Method: The subjects were stroke patients with treatment records in a regional teaching hospital in central Taiwan. Inclusion criteria were: first stroke, hospitalization within 3 days after the stroke, age less than 80 years, and no history of dementia. Patients with severe strokes (NIHSS>15) were excluded. The Mini Mental Status Examination (MMSE) was used to monitor cognitive impairment and the composite intra-cerebral stenosis score (CISS) to evaluate the IVO level. Results: Results showed that of the 201 eligible patients, 127 (63.2%) were male and 74 (36.8%) were female. Age ranged from 50 to 80, and the average was 62.8 years (the standard deviation was 11.2 years). In terms of IVO distribution, there was no significant IVO (CISS=0) in 148 (73.6%) cases, a single IVO (CISS=1) in 21 (10.4%) cases, and multiple IVOs (CISS>=2) in 32 (16.0%) cases. For cognitive function, the results showed that on MMSE assessment six months after discharge, the scores were significantly higher than those on the assessments made in the third month or during admission phase (p <0.05). This showed that the damage due to IVO could be controlled with appropriate medical and home care to effectively improve cognition function. For the group with CISS 0, their cognitive function scores three and six months after discharge were significantly better than those during admission (p<0.05). The results also showed that IVO damage was greater in diabetics. Conclusions: In addition, 79.1% of our patients had hypertension. We therefore suggest that hospital administrations need to strengthen education and care for diabetic and hypertensive patients who live in hospitals or long term-care facilities to prevent permanent injury and cognitive dysfunction as the result of a stroke.