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A Primary Study on the Clinical Characteristics and Mechanisms of Inferential Impairment Caused by Ischemic Cerebrovascular Diseases

Author: ZuoDanYang
Tutor: ZhengJian；ZhaoShiFu
School: Third Military Medical University
Course: Neurology
Keywords: Ischemic cerebrovascular disease Vascular Cognitive Impairment Neuropsychology Cognitive reasoning ability Activities of daily living Ischemic cerebrovascular disease group IL-1β IL-6 IL-8
CLC: R743.3
Type: Master's thesis
Year: 2006
Downloads: 131
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Abstract


Background: The study found that many patients with cerebrovascular disease is not reached before the current dementia diagnostic criteria, have varying degrees of cognitive dysfunction, and seriously affect their daily lives. Severity of clinical dementia diagnostic criteria based on a summary of the clinical symptoms of Alzheimer's disease and to establish, not suitable for the evaluation of vascular cognitive impairment. Therefore, it is necessary to further explore vascular cognitive impairment clinical features of the proposed evaluation and diagnosis of vascular cognitive impairment standard, in order to better guide clinical diagnosis and treatment. Ischemic cerebrovascular disease is a major cause of VCI. The cognitive reasoning is an important aspect of higher cognitive functions, cognitive reasoning ability to damage a direct impact on the patient's work and activities of daily living. Cerebrovascular disease patients with cognitive reasoning capabilities rarely reported in the literature, therefore, it is necessary to further conduct clinical studies of ischemic cerebrovascular disease patients with cognitive reasoning obstacles. Part I: cognitive reasoning damage clinical characteristics of patients with ischemic cerebrovascular disease research purposes: To investigate ischemic cerebrovascular disease patients with cognitive reasoning ability damage situation, analysis of the clinical characteristics of vascular cognitive impairment, asked the vascular recognized known barriers to early diagnosis points to provide clues. Methods: 75 patients with ischemic cerebrovascular disease patients and 30 control group patients without a history of cerebrovascular disease as an object of study. Using the Mini-Mental Intelligence Scale, Raven Reasoning Test, Hamilton Depression Rating Scale neuropsychological testing; application of the U.S. National Institutes of Health Stroke Scale to evaluate neurological deficit; Barthel Index assessment of activities of daily living. Comparison of the indicators in the difference between the two groups by t-test and analysis of variance; different types, different lesion sites of ischemic cerebrovascular disease group classification, comparison disorder characterized by cognitive reasoning; final application analysis method of missing bloody cerebrovascular disease group cognitive reasoning obstacle occurred, and activities of daily living, such as analysis. Results: The comparison of ischemic cerebrovascular disease group and the control group, the MMSE score and CRT-IQ score significantly reduced (p <0.01); a CRT-IQ score, patient group inference disorders rate of 72%; the MMSE itemized The results, in addition to the immediate memory, naming ability and reading ability, the rest of the case group ratings are significantly lower than the control group (p <0.01). Damage caused by different types of cognitive reasoning ability, transient ischemic attack, the vertebrobasilar insufficiency group MMSE score and CRT-IQ scores were significantly better than the other groups (p <0.01); subcortical arteriosclerotic encephalopathy in patients with MMSE total score and the score, especially memory project score and CRT-IQ score was significantly lower than the other ischemic cerebrovascular disease group breakdown. According to the lesion site different grouping of comparison, the results found infratentorial lesions MMSE score or CRT's IQ score significantly higher than cortical lesions and cortical deep white matter lesions (p <0.05), subcortical lesions of the CRT IQ score lower than the other groups (p- correlation analysis results showed that of the of cognitive reasoning obstacle with daily living skills Barthel index of patients with low IQ score of the MMSE total score or CRT, during which there is a significant correlation (r = 0.493,0.440, p <0.01 <0.01); ). Conclusions: 1. Ischemic cerebrovascular disease after reasoning obstacle is one of the important characteristics of, can not be ignored in clinical practice. 2 different types of ischemic cerebrovascular disease causes cognitive reasoning obstacle comparison, patients of the subcortical arteriosclerotic encephalopathy the cognitive reasoning obstacle damage is more serious. 3 the cognitive reasoning obstacle. Different lesion sites of ischemic cerebrovascular disease caused compare subcortical lesions caused damage to the reasoning ability is more prominent. 4 the severity of cognitive reasoning disorders with activities of daily living decline in the presence of a significant positive correlation affect the patient's ability to live one of the important reasons. The second part of the inflammatory cytokines in ischemic cerebrovascular disease patients with cognitive reasoning obstacles role and mechanism of purposes: analysis of cytokines in inflammatory and immune mechanisms of ischemic cerebrovascular disease patients with cognitive impairment, for ischemic a new idea and means for the diagnosis and treatment of cognitive impairment and dementia in cerebrovascular disease. Method: detection by radioimmunoassay in 50 patients with ischemic cerebrovascular disease patients and 20 healthy control group, serum cytokines IL-1β, IL-6, IL-8 level. T-test and the case group and the healthy control group to compare serum cytokines IL-1β, IL-6, IL-8 level. Lesion sites grouped by different causes and different degree of cognitive impairment by analysis of variance on serum cytokines IL-1β, IL-6, IL-8 level. Results: ischemic cerebrovascular disease serum IL-1β, IL-6, IL-8 level was significantly higher than the p-value, respectively: p <0.01, p <0.01, p <0.05. Different etiology of ischemic cerebrovascular disease in patients with IL-1β, IL-6, IL-8 level there are also significant differences in the vertebrobasilar insufficiency and transient ischemic attack group lower. Ischemic cerebrovascular disease group based on its CRT-IQ score between groups divided into no inference obstacles, mild reasoning impairment and serious reasoning obstacle three groups were compared serum in several levels of cytokines, results of serum IL-6 The presence of the most significant differences (p <0.01). Conclusion: Serum IL-1β, IL-6 in the recovery period of ischemic cerebrovascular disease is still at a high level, may play a role in delayed cerebral ischemic injury. 2. Serum IL-1β, IL-6 levels exist some correlation with ischemic cerebrovascular disease, cognitive reasoning obstacles. 3. Serum IL-6 levels in the no reasoning obstacle, mild reasoning impairment, serious differences between the reasoning disorders most significant, is expected to become the biochemical indicators predict cognitive reasoning obstacle.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Cerebrovascular disease > Acute cerebrovascular disease ( stroke)
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