基于蒙特利尔认知评定量表双阈值的卒中后认知“恢复者”神经心理学变化研究

Background Cognitive function is dynamic in post-stroke patientshoweverthere are limited studies on cognitive recovery after stroke. The definition of cognitive reverters and neuropsychological characteristics according to various definitions have not yet been investigated. Objective To investigate the neuropsychological characteristics of cognitive reverters?after stroke based on the traditional definition and new definition according to Montreal Cognitive Assessment MoCA with a double threshold. Methods A total of 163 patients hospitalized for first onset acute ischemic stroke were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2020 to February 2022as the study subjects. All patients were assessed for cognitive function in the acute period of ischemic stroke using the MoCA at baseline. Cognitive function was assessed again at the 6-month post-stroke follow-up with the detailed neuropsychological tests refined at the same timeincluding the digit span task DSTStroop color and word test SCWTChinese version of Boston naming test BNTverbal fluency testVFTclock drawing testCDTand auditory verbal learning testAVLT. The enrolled patients were divided into the M1 group MoCA scores <21M2 group 21 ≤ MoCA scores ≤ 25and M3 group MoCA scores ≥ 26according to the MoCA with adouble threshold. While the patients were also divided into the reverters 1R1 groupnonreverters 1NR1 groupR2group and NR2 group according to the two definitions of reverters. Results Patients were followed up after 6 monthsof which 28 were lost to follow-up and 135 were finally included in the study. The average MoCA score in the acute period of stroke was 20.1±5.1 in 135 patients. There were 40 cases in the M1 group61 cases in the M2 group and 34 cases in the M3 group. The scores of the MoCAforward DSTreverse DSTtotal DSTChinese version of BNTCDTStroop C time consumingnumbers of VFT-animalVFT-fruit and VFT-vegetableAVLT-immediate scoresAVLTshort delay scoresAVLT-long delay scores and AVLT-recognition scores in the M2 and M3 groups6 months after stroke were higher than the M1 groupP<0.05.The scores of the MoCAreverse DSTtotal DSTAVLT-short delay score and AVLTlong delay score in the M3 group than the M2 groupP<0.05.120 patients of the 135 patients with MoCA scores<26 in the acute period of ischemic stroke were selected as the study subjects. Compared with the MoCA scores during the acute period of ischemic stroke73 patients improved ≥ 2 points during the follow-up period in the R1 group and 47 patients improved <2 points in the NR1 groupwith a recovery rate of 60.8% 73/120.Patients in the R1 group had lower MoCA scores in the acute period of ischemic stroke than the NR1 groupand higher MoCA scores in the follow-up period than the NR1 group P< 0.05.Compared with the double threshold classification of MoCA in the acute period of stroke50 cases had increased scores and crossed over to the R2 group and 70 cases did not cross over to the NR2 group at follow-upwith a recovery rate of 41.7% 50/120.Patients in the R2 group had higher MoCA score in the acute period of strokeMoCA scoresreverse DST scorestotal DST scoresChinese version of BNT scoresVFT-vegetable numberCDT scoresAVLT-immediate scoresAVLT-short delay scoresAVLT-long delay scoresand AVLT-recognition scores during follow-up were higher than the NR1 groupand the Stroop C time consumingnumbers of Stroop C errors and VFT-animals were lower than the NR1 group P<0.05. Conclusion There are varying degrees of impairment in attentionvisuospatial function and delayed recall in post-stroke patients. There is no significant difference in neuropsychological characteristics between reverters and nonreverters. Howeverthe scores of reverters are higher based on the definition using double threshold for MoCA scoreswhich is more relevant for clinical use.