Dissertation > Medicine, health > Neurology and psychiatry > Psychiatry > Cerebral organic mental disorder

The Clinical Observing of Vascular Cognitive Impairment after Cerebral Infarction

Author WangLiPing
Tutor YangHong
School Jilin University
Course Neurology
Keywords Cerebral infarction Vascular Cognitive Impairment Neuropsychological
CLC R749.1
Type Master's thesis
Year 2006
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Cognitive impairment is a most frequent syndrome of acute cerebralinfarction .it not only affect the patients’ social adaptive ability ,but also affectthe total rehabilitation of cerebral vascular diseases. Many patients ofcerebral infarction develop into vascular dementia because cognitiveimpairment can’t be diagnosed and treat.vascular dementia after cerebralinfarction has no effective treatment ,and this has become a big challengefor modern medicine. In recent years mang scolars put forward the conceptof vascular cognitive impairment VCI .it has been a new topic which perhapshelps to improve prognosis and decrease occurring of cerebralinfarction.So the researching for VCI is important.VCI is a wider domain ,and its aim is to offer treatment to cognitiveimpairment before dementia. Combining the international adwancement,Theconcept of VCI is a kind of syndrome from mild cognitive impairment todementia due to the risk factors for cerebral vascular diseases (etc highblood pressure ,diabetes ,hiperdipemia)and obvious or unconspicuous cerebralvascular diseases (etc white matter looseness and chronic cerebralhemorrhage.The concept of VCI cover the whole course of cognitiveimpairment from mild to severe due to vascular factor .it cues people to putemphases onto diagnosis and treat of VCI ,in order to let patients be treatedbefore vascular dementia. The factors which affect VCI include not onlycerebral stroke but also various risk factors,for example, risk factors forarteriosclerosis : high blood pressure ,diabetes , abnormity of blood lipid,cardiopathy smoking and drinking,etc. the numbers and location of cerebralinfarction are all key foctors for cognitive impairment.To research neuropsychological characters of VCI after cerebralinfarction and discuss its clinic significance, thereby strengthen clinicunderstanding of VCI ,this study adopts MMSE and Barthel etc to test CIpatients’ neuropsychology,and also analyse the results in order to offerevidence for the prevention,diagnosis and treatments of VCI.We select 50 CI patients (CI group),and 50 matched normal control,andall patient come from in-patients and policlinic patients who do medicalexamination for health at the department of neurology in China Japan UnionHospital of Jilin University.these people are all examed by MMSE, BI, andHIS.the results indicate the incidence of cognitive impairment of CI patientsis distinctly higher than normal contral ,and most of cognitive impairment ismild;the abilities of activities of daily living of CI patients dropeddistinctly.The early research indicates that the weight and volume of the brain andthe reduce of number of cells of cortex of the brain have association withage .some people consider that cognitive function may have association withage for that cortex of the brain complexly relate to higher brainpower. Theresult of Gorelick and Tatemichi’s research indicates that age have impact oncognition post of stroke ,and consider that age is a big risk factor for dementiarelated to stroke .this research supports the points above . the differencebetween the group of older than 60 and younger than 60 is significant inMMSE but not in Barthel . cognitive function of group of older than 60 isworse than group of younger than 60, and there is no significant differencebetween them on abilities of activities of daily living . Some literature reportthat 76% of VD patients and 57% of Vascular CIND patients have sufferedfrom the stroke .but perhaps there are only 5% AD patients who have sufferedfrom the stroke.it would be 7% of normal contral .there is also researchdiscovered that the patients who have suffered from the stroke more thantwo times or whose course of first-time stroke has been one to threeyears are high danger people for vascular dementia . we also found thatcognitive function drop distinctly who have suffered from the stroke .High blood pressure for long time can lead to cerebral arteriosclerosis andaggravate cognitive impairment . literatures display high blood pressure isthe most important risk factor . high blood pressure relates to pathologicalchange of small vessel .55% of VD patients and 48% of CIND patientssuffer from high blood pressure.,and 24% of possible AD patints ,38% ofnormal contral .we can reduce the incidence of VCI or stave thedevelopment of course of VCI through intervene high blood pressure.Ourstudy shows high blood pressure is important risk factor of VCI The patientsof cerebral vascular disease especially ischemic cerebral stroke oftenincorporate with diabetes .The study abroad high blood sugar and high blood lipid relate tocognition ,the pathological changes of tiny vessel of diabetes reduce bloodflow of cerebral cortex especially frontal and tempal lobe and bring theletdown of cognitive function .which often present the ability of memoryand thought acting decline. This study found that the cognition declinedistinctly in group of diabetes .The intelligence ,memory feelings of patients of cerebral infarctionrelate to number and location of infarction focus nearly. The multifocus domore damage to brainpower ,memory ,feelings than a single focus.Generally speaking, a definite part of the brain is relevant to somebehavior .the activity of the brain is unitary.the relation between activity andthe brain is not singlly linear.often a definite part of the brain is oftenrelevant to multiple behavior.and some complex behavior also haveassociation to multiple location of the brain. Some studys showed that thecognitive impairment after stroke relates to number of injured cerebraltissue and infarction ,the location of impairment ,and extent of cerebralatrophy. For the sample is small,this study can’t investigate every area of thebrain injured on cognition.only we can do is to study rudely how the iniuredarea of the brain include frontal lobe ,temporal lobe and the area of basalnuclei impact on cognition,and multiple and single focus’ impact on cognition.Compared to the focus of area of basal nuclei ,The gradeof MMSE of frontaland temporal lobe is lower ,so did the single focus when compared to multiplefocus .The reason for this maybe : (1)the frontal lobe relates to spirital activityof motorial activity and judgement ,foresee ,mood , state of mind and soon;temporal relates to sensibility ,feeling, memory .so infaction of the frontaland temporal lobe can lead to grievous cognitive impairment . (2) thecerebral infarction can induce cerebral tissue anoxic and short of bloodflow..this consequently leads to change of structure and function oflocal or broad cerebral tissue.the list of MMSE includes directing of visionand space , remembrance, calculation ,and speech ,etc.while these function isnot completed by some location of cerebrum ,but is the result of cooperatingof the whole cerebrum.so the broad impairment of the cortex and under cortexinduced by multiple infaction can lead to severe cognitive impairment. Peopleincluding Bowler consider that the number and location and so forth ofcerebral infarction is the key factor of cognitive impairment .the results of thisstudy match the points above.To sum up ,we examed neuropsychology of VCI patients who arediagnosed by CT by MMSE, BI,etc .,and analyzed .we drew conclusionsfrom the study as follow: the incidence of cognitive impairment of CI patientsis distinctly higher than normal contral ,and most of cognitive impairment ismild;the abilities of activities of daily living of CI patients droped distinctly;the incidence of cognitive impairment of CI patients have association withage, records of stroke ,diabetes,location and the number of lesions, and haveno distinct association with high blood preassure . the abilities of activitiesin daily living of CI patients have no distinct association with age, historyof stroke ,diabetes, high blood preassure ,location and the number of lesions.

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