Zhongguo cuzhong zazhi (Aug 2019)
缺血性卒中后焦虑抑郁与认知功能障碍的关系研究 Relationship of Post-stroke Depression and Anxiety with Cognitive Impairment
Abstract
【摘要】 目的 探讨缺血性卒中后焦虑抑郁与认知功能障碍的关系。 方法 选取2017年1月-2018年3月邯郸市第一医院收治的首发缺血性卒中患者98例，同期非缺血性卒中入院的患者50例作为对照组。分别进行汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA）、汉密尔顿抑郁量表（Hamilton depression scale，HAMD）、日常生活能力量表(activity of daily living scale，ADL)、蒙特利尔认知评估量表（Montreal cognitive assessment，MOCA）和NIHSS评测。比较两组的认知功能障碍和焦虑、抑郁发生情况；对卒中组的ADL、MoCA、NIHSS评分与HAMA、HAMD评分进行相关性分析；对ADL、MoCA、NIHSS评分进行相关性分析。 结果 卒中组中62例（63.3%）患者存在认知功能障碍，存在焦虑者53例（54.1%），抑郁者42例（42.9%），对照组中存在认知功能障碍者14例（28%），存在焦虑者17例（34.0%），抑郁者9例（18.0%）。卒中组MoCA和ADL评分均低于对照组，差异均有统计学意义。卒中组HAMA评分与ADL、MoCA和NIHSS评分相关系数分别为r=-0.526（P＜0.001）、r=-0.592（P＜0.001）和r=0.412（P＜0.001）；HAMD评分与ADL、MoCA和NIHSS评分的相关系数分别为r=-0.490（P＜0.001）、r=-0.571（P＜0.001）和r=0.606（P＜0.001）；ADL与MoCA、NIHSS评分的相关系数分别为r=0.933（P＜0.001）和r=-0.842（P＜0.001）；MoCA与NIHSS评分的相关系数为r=-0.911（P＜0.001）。 结论 ①缺血性卒中后焦虑及抑郁的发生率较高且与认知功能障碍相关；②缺血性卒中后焦虑、抑郁越重，其神经功能缺损的程度越重，日常生活能力越差。 【Abstract】 Objective To explore the relationship of post-stroke depression and anxiety with cognitive impairment. Methods 98 patients with first ischemic stroke who were admitted to the First Hospital of Handan from January 2017 to March 2018 were selected. 50 inpatients with non-stroke in the same period were chosen as control group.The patients of the two groups were assessed using the following scales within 2 days after hospitalization, including Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), activity of daily living scale (ADL), Montreal cognitive assessment (MOCA) and NIHSS. The cognitive impairment, anxiety and depression in both groups were analyzed. The correlation analysis of ADL, MoCA, NIHSS and HAMA, HAMD scores were performed. Results 62 (63.3%) patients in stroke group were diagnosed with cognitive dysfunction, 53 (54.1%) patients with anxiety, and 42 (42.9%) patients with depression; while in control group, 14 (28%) cases with cognitive dysfunction, 17 (34.0%) ones with anxiety, and 9 (18.0%) ones with depression. The MoCA and ADL scores in stroke group were both lower than that in control group, and the differences were statistically significant. The correlation analysis of HAMA and ADL, MoCA, NIHSS score showed that the correlation coefficients r=-0.526 (P<0.001), r=-0.592 (P<0.001) and r=0.412 (P<0.001), respectively; the correlation coefficients of HAMD score and ADL, MoCA, NIHSS were r=-0.490 (P<0.001), r=-0.571 (P<0.001) and r=0.606 (P<0.001), respectively. The correlation coefficients of ADL, MoCA and NIHSS were r=0.933 (P<0.001) and r=-0.842 (P<0.001). The correlation coefficient of MoCA and NIHSS was r=-0.911 (P<0.001). Conclusions The incidence of anxiety and depression after ischemic stroke were higher, and they were both correlated with cognitive impairment. The more severe post-stroke anxiety and depression, the more serious the neurological deficit and the worse the activity of daily living.
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