Minör inmeli ve geçici iskemik ataklı hastalarda kognitif fonksiyonların belirlenmesi ve takibi
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Tarih
2011
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Serebrovasküler hastalık, sadece nörolojik defisitler nedeniyle değil, aynı zamanda kognitif fonksiyonda ortaya çıkan bozukluklar nedeniyle de hayat kalitesinde önemli derecede azalmalara neden olmaktadır. Vasküler kognitif bozukluk terimi ise bu kognitif etkilenmenin tüm derecelerini içermektedir. Biz bu çalışmada, strokta kognitif bozulmanın rastlanma sıklığını, etkileyen risk faktörlerini, progresyonunu, Manyetik Rezonans Görüntüleme ile lezyon lokalizasyonunu ve bu lokalizasyonun, etkilenen kognitif fonksiyonlarla olan ilişkisini değerlendirmeyi amaçladık. Çalışmamıza 18 yaş üstü, son üç ay içerisinde geçici iskemik inme veya minör inme geçiren,1 yıllık yaşam beklentisi olan 40 hasta ile 40 kontrol vakası alınmıştır. Minör inme kriteri olarak; National Institutes of Health Stroke Scale skoru 5 ve altı olarak kabul edilmiştir. Hastaların lezyon lokalizasyonları için Oxfordshire Community Stroke Project klinik Subtipleri göz önüne alınmıştır. Hastalarda strok risk faktörlerinden; internal karotid arter stenozu, diyabet, hipertansiyon, koroner arter hastalığı, atrial fibrilasyon, sigara kullanımı ve hiperlipidemi sorgulanmıştır. Hasta ve kontrol gruplarına, kognitif fonksiyonları değerlendirmek için, bir dizi nöropsikolojik test kullanılmıştır. Dikkati değerlendirmek için sayı menzili, sözel bellek için kelime listesi belleği, kelime listesi hatırlama ve kelime listesi tanıma, dil için Boston adlandırma testi, vizüospasyal işlevler için konstrüksyon yeteneği, görsel bellek ve saat çizme testi kullanıldı. Ayrıca soyut düşünme testi, hesaplama testi, frontal yürütücü işlevleri değerlendiren Frontal Assessment Batery Testi ve genel değerlendirme için ise mini mental test kullanılmıştır. Bu çalışmada iskemik strok sonrası kognitif testlerin çoğunda bozulma izlenmiş olup; altıncı ve onikinci aylarda yapılan takiplerde ise sadece geri sayı menzili testinde anlamlı düzelme saptanmıştır. Diğer testlerde anlamlı düzelme olmamakla beraber hesaplama testi hariç anlamlı kötüleşmede saptanmamıştır. Risk faktörleriyle kognitif bozulma arsındaki ilişki incelendiğinde ise KAH ve AF'si olan hastalarda eşit oranda ve en yüksek kognitif bozulma oranları izlenmiştir.Ayrıca 70 yaşın üzerindeki hastalarda ve de sol hemisfer lezyonu olan hastalarda kognitif bozulma oralarının daha yüksek seyrettiği tespit edilmiştir. Sonuç olarak; iskemik stroklu hastalarda akut dönemde kognitif değişiklikler çok belirgin olup, bu değişiklikler lezyonun lokalizasyonuna, risk faktörlerine göre farklılık gösterebilir. Bu nedenle iskemik strok sonrası gerçekleşen kognitif etkilenmenin ayrıntılı nöropsikolojik testler, görüntüleme, klinik bulgular ile birlikte kapsamlı olarak değerlendirilmesi gerekmektedir.
Abstract
Cerebrovascular diseases impair the quality of life by not only the neurologic deficits they cause,but also by the impairments in cognitive functions. The term, vascular cognitive impairment involves all degrees of this effect on cognition. In our study, we aimed to evaluate the frequency of cognitive impairment in stroke , related risk factors, progress , determination of the lesion localization by Magnetic Resonance Imaging and the relation of the localization with the effected cognitive functions. Forty patients with history of transient ischemic stroke or minor stroke within three months,over 18 years of age with a life expectancy of 1 year and 40 controls were enrolled in the study. National Institutes of Health Stroke Scale score 5 was accepted as minor stroke. Oxfordshire Community Stroke Project clinical subtypes were accepted for lesion localizations. Internal carotid arter stenosis, diabetes, hypertension, coronary arter disease, atrial fibrilation, smoking, status and hyperlipidemia were investigated as stroke risk factors. Certain neuropsychiatric tests were used to assess cognitive functions on both patient and control groups. Digit span test to assess attention, word list memory, word list recall and recognition tests, Boston Nomenclature test for language , contruction skill for visuospatial functions, visual memory and clock drawing test were used. National thinking test, calculation test , Frontal Assessment Batery test for frontal executive functions and Mini-Mental State Examination was used for general assessment . In this study, cognitive impairment was observed in the tests taken after ischemic stroke .During follow up at months 6 and 12. significant improvement was observed only in the `digit span test test. In the other tests no significant improvement was observed and with the exception of the calculation test no significant impairment was observed neither. In analysis of the relationship between risk factors and cognitive impairment, cognitive impairment was found to be highest and in equal proportions in coronary artery disease and atrial fibrillation patients. Additionally, the rate of cognitive impairment was observed to be highest in patients aged above 70 years and in those with left hemisphere lesions. Cognitive impairment was very frequent in patients with ischemic stroke and these alterations may differ according to the localization of the lesion as well as the risk factors. Therefore, the effects of ischemic stroke on cognitive functions should be assessed with through neuropsychological tests, imaging ,clinical findings.
Abstract
Cerebrovascular diseases impair the quality of life by not only the neurologic deficits they cause,but also by the impairments in cognitive functions. The term, vascular cognitive impairment involves all degrees of this effect on cognition. In our study, we aimed to evaluate the frequency of cognitive impairment in stroke , related risk factors, progress , determination of the lesion localization by Magnetic Resonance Imaging and the relation of the localization with the effected cognitive functions. Forty patients with history of transient ischemic stroke or minor stroke within three months,over 18 years of age with a life expectancy of 1 year and 40 controls were enrolled in the study. National Institutes of Health Stroke Scale score 5 was accepted as minor stroke. Oxfordshire Community Stroke Project clinical subtypes were accepted for lesion localizations. Internal carotid arter stenosis, diabetes, hypertension, coronary arter disease, atrial fibrilation, smoking, status and hyperlipidemia were investigated as stroke risk factors. Certain neuropsychiatric tests were used to assess cognitive functions on both patient and control groups. Digit span test to assess attention, word list memory, word list recall and recognition tests, Boston Nomenclature test for language , contruction skill for visuospatial functions, visual memory and clock drawing test were used. National thinking test, calculation test , Frontal Assessment Batery test for frontal executive functions and Mini-Mental State Examination was used for general assessment . In this study, cognitive impairment was observed in the tests taken after ischemic stroke .During follow up at months 6 and 12. significant improvement was observed only in the `digit span test test. In the other tests no significant improvement was observed and with the exception of the calculation test no significant impairment was observed neither. In analysis of the relationship between risk factors and cognitive impairment, cognitive impairment was found to be highest and in equal proportions in coronary artery disease and atrial fibrillation patients. Additionally, the rate of cognitive impairment was observed to be highest in patients aged above 70 years and in those with left hemisphere lesions. Cognitive impairment was very frequent in patients with ischemic stroke and these alterations may differ according to the localization of the lesion as well as the risk factors. Therefore, the effects of ischemic stroke on cognitive functions should be assessed with through neuropsychological tests, imaging ,clinical findings.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Demans, Vasküler Risk Faktörleri, Post-strok Kognitif Fonksiyon, Kognitif Bozulma, Vasküler Demans, Cognitive Impairment, Vascular Risk Factors, Dementia, Vascular Dementia, Post Strok Cogntive Function
