摘要
目的:全国每年新发的脑卒中患者人数约两百万,认知功能减退是急性脑卒中患者最常见的表现之一。认知功能减退不但影响患者的社会适应能力与日常生活,而且影响脑卒中的全面康复、治疗与二级预防。本项研究旨在对卒中后认知功能减退的特点、其相关影响因素以及中医证候特征进行研究,对早期诊断、预防和临床治疗卒中后认知功能减退具有重要指导意义。
方法:对50例新发脑梗死非痴呆患者应用简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(北京版)、DS量表在发病14天、1月、3月定期评定认知功能,完善相关辅助检查,包括头颅核磁共振(MRI)检查,多时点采集中医四诊信息,并对血压、血糖、血脂等进行检测和相关病历资料分析。MoCA量表子项目交替连线试验、视空间试验、画钟试验的组合是最佳分析方法,把发病3月时点交替连线试验<1分、视空间试验<1分、画钟试验<3分的并集结合MoCA量表推荐分值(减退值〈26分)作为卒中后认知功能减退的评判标准,当中患者归属于卒中后认知功能减退组,其余属于卒中后认知功能无减退组。
结果:①发病前3月总体MMSE量表与MoCA量表、DS量表分值逐渐升高。MMSE量表时空定向力、计算力,MoCA量表命名、计算力、延迟回忆、定向力快速恢复,书写、绘画能力、连线试验、视空间试验、画钟试验、抽象力、语言重复力减退缺损人数持续高水平且减少缓慢;②卒中后认知功能减退组双侧、多发病灶、皮层、基底节、侧脑室扩大梗塞患者比例明显高于无认知功能减退组,卒中后认知功能减退组高龄段人数所占比例明显高于无认知功能减退组,卒中后认知功能减退组饮酒、嗜荤的患者比例远低于卒中后认知功能无减退组。认知功能减退组的阳虚体质的人所占比例明显高于认知功能无减退组。③认知功能减退组痰证、阴虚证分值均值在发病1月、3月高于认知功能无减退组,有统计学差异。认知功能减退组气虚证分值均值在发病14天、1月、3月均高于认知功能无减退,有统计学差异。
结论:①脑梗死患者存在一定程度的早期认知功能损害,以书写、绘画能力、连线试验、视空间试验、画钟试验、抽象力、语言重复力受损为主要特征,发病前3月认知功能总体趋势好转;②本项研究提示头颅核磁共振(MRI)检查双侧、多发病灶、皮层、基底节、侧脑室扩大、年龄、饮酒、嗜荤、阳虚体质很可能与卒中后认知功能减退有关系。③本项研究提示中医的痰证、气虚证、阴虚证可能是卒中后认知功能减退的主要证候。
Objective:Every year the number of stroke patients is about 2 million and cognitive dysfunction in patients with acute stroke are the most common manifestations.The impact of cognitive decline in patients with not only the ability to adapt to everyday life and society and the impact of a comprehensive stroke rehabilitation,treatment and secondary prevention after cerebral infarction.This study aimed at the characteristics of cognitive decline and its related factors,as well as to study the characteristics of syndromes for early diagnosis,prevention and provide a basis for clinical treatment.
Methods:50 cases of non-demented patients with new cerebral infarction are assessed with mini-mental state examination(MMSE) and Montreal Cognitive Assessment Scale(Beijing edition),DS Scale at 14 days,1 month,3 month of onset to assess cognitive function in a regular basis,at the same time using the Ranking Scale,I ADL Scale, BI Scale,NIHSS Scale,as well as other areas to assess and improve the relevant examinations,including cranial magnetic resonance imaging(MRI)examination,collection of Chinese medicine for some time points four patient information and blood pressure,blood glucose, blood lipids,such as testing and related medical data analysis.Scale MoCA connection sub-turn test,depending on space experiments,a combination of draw bell test is the best analytical methods,the incidence of 3 month pilot to connect the turn point in time<1 point, depending on the space test<1 point,draw bell test<3 points combining recommend MoCA scores(reduced value of<26 points)as a post-stroke cognitive decline of the evaluation criteria,which attributed to post-stroke patients with cognitive decline group,and the rest belong to non-cognitive function after stroke reduced group.
Results:①After 3 months,MMSE Scale and MoCA Scale,DS Scale score increased gradually.Spatial orientation when the MMSE scale,and calculating the force,MoCA named scale,computing power,memory delay,express recovery orientation,writing,painting,capacity,the connection test,depending on space experiments,draw bell test, abstract,and duplicate language ability reduced defects come back to the number of high-level slowly;②Cognitive decline after stroke group with bilateral,multiple lesions,the cortex,basal ganglia, lateral expansion of infarction was significantly higher than the proportion of patients without cognitive decline groups,the cognitive decline group average age was significantly higher than the non-cognitive decline group;post-stroke cognitive decline group′drinking,meatting anopheles rate is much lower than that of non-cognitive decline group.Group cognitive decline of people Yangxu constitution was significantly higher than normal cognitive function.
③In Cognitive decline group,Tan,yin deficiency′mean score is higher than the non-cognitive decline group at 1 month,3 month,and there is significant difference between the differences.In Cognitive decline group qi deficiency′mean scores at 14 days,1 month,3 month were higher than normal cognitive function group,and there is significant difference between the differences.
Conclusion:①There is a certain degree of cerebral infarction in patients with early cognitive impairment to writing and painting capacity,the connection test,depending on space experiments,draw bell test,abstract,and language impaired to duplicate and this is the main features of cognitive dysfunction;In March prior to the onset,improvement is in the overall trend;②NMR study prompted the head(MRI)examination of bilateral,multiple lesions,the cortex, basal ganglia,lateral expansion of,age,alcohol,meat Anopheles, yangxu constitution may be related to cognitive function.③Tan,Qi deficiency,Yin deficiency are the major syndromes of post-stroke cognitive decline.
引文
[1]Hauer K,Becker C,Lindemann U,et al.Effectiveness of Physical Training on Motor Performance and Fall Prevention in Cognitively Impaired Older Persons:A Systematic Review[J].Am J PhysMed Rehabil,2006,85(10):847-857.
[2]廖小平,文国强,等.急性脑梗死患者认知功能障碍与病灶部位的相关性研究[J].中风与神经疾病杂志,2007,24(1):71-72.
[3]王智光等脑梗死 MRI 表现与患者认知功能障碍及抑郁关系的研究[J].中风与神经疾病杂志,2007,24(2):220-222.
[4]陈湛愔等.脑梗死后情感障碍与认知功能障碍关系及其影响因素的研究[J].中西医结合心脑血管病杂,2008,28(4):627-629.
[5]Ballard C,Roman E,Stephens S,etal.Prospective follow-up study between 3 and 15 months after stroke:improments and decline in cognitive function among dementia-free stroke survivor>75 year of age[J].Stroke,2003,34(10):2440-2444.
[6]Rockwood K.Vascular cognitive impairment and vascular dementia.[J].J Neurol Sci,2002,23(7):203-204.
[7]Boysen G,Brande T,Christense H,et al.Homocysteine and risk of recurrent stroke[J].Stroke,2003,34(5):1258-1261.
[8]聂志芳,陈长香等.482例脑卒中患者认知障碍及危险因素[J].现代预防医学,2008,35(6):1172-1173.
[9]田佳等.A survey of cognition functional disorder among cerebral apoplexy patien[J].CHINESE NURSING RESEARCH,2007,21(12):3136-3137.
[10]Barnett HJ.Carotid disease and cog native dysfunction[J].Ann Intern Med,2004,140(2):303-304.
[11]陈康宁等.颈动脉支架成形术对认知功能的影响[J].中国卒中杂,2007,2(6):472-473.
[12]Argyriadou S,Vlachonikolis I,Melisopoulou H,et al.In what extent anemia coexists with cognitive impairment in elderly:across-sectional study in Greece[J].BMC Fam Pract,2001,3(6) 2:5.
[13]Milward EA,Grayson DA,Creasey H,et al.Evidence for association of anaemia with vascular dementia[J].Neuroreport,1999,10(3):2377-2381.
[14]付华斌等.脑卒中患者急性期血糖、血脂与认知功能障碍的相关性分析[J].四川医学,2007,28(2):130-132.
[15]刘海艳,张哲成.血浆同型半胱氨酸与腔隙性脑梗死及认知功能关系[J].中国临床神经科学,2007,15(6):629-632.
[16]黄延焱.血清中胰岛素样生长因子-1水平与脑卒中后痴呆关系的研究[J].中华老年心脑血管病杂志,2007,9(5):304-307.
[17]Wehr H,Parnowski T,Puzynski S,et al.Apolipoprotein E genotype and lipid and lipoprotein levels in dementia[J].Dement Geriatr Cogn Disord,2000,11(5):70-7.
[18]Wehr H,Parnowski T,Puzynski S,et al.Apolipoprotein E genotype and lipid and lipoprotein levels in dementia[J].Dement Geriatr Cogn Disord,2000,11(8):70-7.
[19]Yang J,Feng G,Zhang J,et al.Is ApoE gene a risk factor for vascular dementia in Han Chinese?[J].Int J Mol Med,2001,7(12):217-219.
[20]武红斌.养血清脑颗粒治疗血管性痴呆病人临床观察[J].中西医结合心脑血管病杂志,2007,5(11):1036-1070.
[21].王延江等.首次卒中后认知功能损害危险因素的研究[J].重庆医学,2008,37(7):688-690.
[22]Salerno-Kennedy R,Cashman KD.Relationship between dementia and nutriat ion-related factors and disorders:an overview[J].Int J Vitam Nutr Res,2005,75(2):83-95.
[23]Ohayon MM.Vecchierini MF.Daytime sleepiness and cognitive impairment in the elderly population[J].Arch Intern Med,2002,162(2):201-208.
[24]杜琼.脑卒中后认知障碍与日常生活活动相关性调查[J].当代护士,2008,39(2):39-40.
[25]范宝玉,邓雪珍.脑卒中患者认知功能康复对提 ADL 能力分的影响[J].心血管康复医学杂志,2002,11(3):35-36.
[26]Landi F,Cesari M,Onder G,etal.Non-steroidal anti-inflammatory drug(NSAID) use and Alzheimer disease in connunity-dwelling elderly patients[J].Am J Geriatr Psychiatry,2003,11(2):179-85.
[27]谢颖祯,邹忆怀,张云岭.血管性痴呆病因病机探讨[J].北京中医药大学学报,2000,23(6):1-3.
[28]刘垣田,田金洲.血管性痴呆患者证候学研究[J].北京中医药大学学报,2006,29(1):52-55.
[29]许凤华.卒中后认知功能障碍辨治[J].河南中医,2005,27(4):41-42.
[30]郑岚,沈小珩.百岁方颗粒剂对脑梗死患者认知功能障碍的干预作用[J].中西医结合学报,2004,2(4):258-261.
[31]许景强,陆曦.通心络胶囊治疗老年血管性痴呆疗效观察[J].中外健康文摘,2007,4(10):32-33.
[32]赵淑杰.谷红注射液治疗脑梗死后认知障碍186例疗效分析[J].实用心脑肺血管病杂志,2006,14(11):893.
[33]张春燕.培元活血通络法对缺血性脑卒中后认知和生活能力的影响[J].中国老年学杂志,2006,26(5):622-623.
[34]谢冬玲等.头皮针对脑卒中康复期患者认知与运动功能障碍疗效观察[J].中国康复理论与实践,2007,13(6):542-543.
[35]张立,唐强.头穴丛刺改善脑卒中后认知功能障碍[J].针灸临床杂志,2007,23(6):27-28.
[36]吴勃力,于惠敏,杨沈秋,等.于致顺教授治瘫经验[J].中国针灸,1997,17(3):153-154.
[37]于晓刚等.以针刺督脉经穴为主治疗缺血性脑卒中后轻度认知功能障碍的临床观察[J].中西医结合心脑血管病杂志,2005,5(12):1171-1173.
[38]Ye Q,Wu RZ,Li HL.Huperzine A for improving the memory and cognative function in patients with organic brain diseases[J].Chinese Journal of Clinical Rehabilition,2005,9(36):128-9.
[39]Zhang JH,Fan JZ,Peng N.Functional training combined with almitrine-raubasine treatment for improving cognitime function of patients with severe craniocerebral injury[J].Chinense Journal of Clinical Rehabilitation,2005,9(36):134-136.
[40]茅跃平.盐酸多奈哌齐治疗卒中后轻度认知功能损害的疗效观察[J].中国老年保健医学,2006,4(2):22-23.
[41]李长安等.曲克芦丁脑蛋白水解物注射液治疗血管性认知功能障碍临床观察[J].中国基层医药,2006,13(8):1372.
[42]夏圣梅,孙洪波.高压氧对脑卒中后认知功能障碍疗效观察[J].中国老年学杂志,2004,24(8):707-708.
[43]王毓雯.高压氧+综合康复训练治疗脑卒中认知功能障碍疗效观察[J].山东医药,2007,47(34):107-108.
[44]林海燕,徐海前,刘改生.脑卒中恢复期认知功能运动功能的关系[J].浙江预防医学,2003,15(4):72-73.
[45]谢瑛.急性完全性脑卒中超早期康复对运动及认知功能的影响[J].现代医药卫生,2007,23(7):960-962.
[46]张华,王宏娟等.肌电生物反馈疗法对急性脑梗死患者神经功能及认知障碍的影响[J].中国康复,2007,22(4):232-233.
[47]李舜等.脑卒中后认知障碍的计算机辅助康复训练结合盐酸多奈哌齐治疗[J].中国康复,2007,22(4):241-242.
[48]姜鹭春等.集体娱乐活动对脑卒中患者认知功能的影响[J].中国康复医学杂志,2008,23(3):258-259.
[49]Barba R,Martinez Espinosa S,Rodriguez Garcia E,et al.Post stroke dementia:clinical features and risk factors[J].Stroke,2000,31(4):1494-1501.
[50]Rockwood K,Ebly E,Hachinski V,et al.Presence and treatment of vascular risk factors in patients with vascular cognitive impairment[J].Arch Neurol,1997,54(1):33-39.
[51]韩振蕴,张允岭,石任兵等.清脑滴丸治疗腔隙性脑梗死的临床研究[J].北京中医药大学学报,2004,27(2):83-86.
[52]仇成轩.老年血管性认知功能损害及其预防[J].中华老年心脑血管病杂志,2004,6(2):74-75.
[53]李树贞,赵曦光.康复护理学[M].北京:人民军医出版社,2001.107-109.
[54]丘翠竹,何国雄,张彩莲,等.血管性痴呆患者行为干预的研究[J].现代护理杂志,2004,10(4):297-299.
[55]刘素美,单春娥,吕金英,等.3R 护理对老年血管性痴呆的影响[J].实用护理杂志,2000,16(8):3-4.
[56]许红梅,刘化侠.老年痴呆干预方法的进展[M].国外医学护理学分册,2003,22(10):451-455.
[57]许红梅,刘化侠.对老年痴呆行为给予以理论为基础的行为干预[M].国外医学护理学分 册,2003,22(3):140-141.
[58]陈庆.认知护理早期干预对血管性痴呆认知功能障碍的影响[J].现代中西医结合杂志,2004,13(24):3313.
[59]王玲,杨莘,张亚荣,等.4例老年性痴呆患者认知训练方法的探讨[J].中华护理杂志,2005,40(11):848-850.
[61]张少茹,李小妹,王作仁.老年痴呆的护理进展[M].国外医学护理学分册,2003,22(2):62-64.
[62]李静,邹凌燕.老年痴呆病人的护理现状及其展望[J].护理学杂志,2003,18(8):638-639.
[63]张少茹,李宁,张银萍.老年痴呆照料者的困扰与生活质量的相关性研究[J].中国实用护理杂志,2004,20(4):58-59.
[1]王永炎,沈绍功.今日中医内科[M].北京:人民卫生出版社,1999:302.
[2]田金洲,王永炎,刘恒等.血管性痴呆发病机理的研究[J].中医杂志,2003,44(8):565.
[3]武月萍,宫洪涛,张建刚,等.论血管性痴呆与肾[J].中国中医急症,2003,12(1):45-46.
[4]刘兴山,王静慧.补肾活血化痰法治疗血管性痴呆的临床研究[J].中国老年学杂志,2005,25(6):657-9.
[5]罗薇,阎小萍,王昊,等.补肾益精祛痰化瘀法治疗血管性痴呆浅识[J].中医药学刊,2004,22(2):338-339.
[6]黄启辉,魏昌秀,潭朝晖,等.李庆明教授治疗老年痴呆经验[J].河北中医,2005,27(12):885-886.
[7]卫振华.血管性痴呆的中医病机及辨制治思路[J].山西中医,2005,21(6):1-2.
[8]刘兴山,王静慧.补肾活血化淤法管性痴呆的临床[J].中国老年学杂志.,2005,25(6):657-659.
[9]郭振球.老年期痴呆的证治学研究[J].中医药研究,1991,2(1):16.
[10]赵南刚,况时祥.试述肝阳亢盛与血管性痴呆的关系[J].实用中医药杂志,2006,22(3):174-175.
[11]刘秀蓉,周伟.血管性痴呆从肝论治[J].山东中医杂志,1998,17(1):5-6.
[12]任继学.伏邪探微[J].长春中医学院学报,2005,21(1):4-7.
[13]常富业,王永炎,高颖,等.病络机制与痴呆证治述要[J].中医研究,2006,18(5):1-3.
[14]杨辰华,王永炎,王新志.血管性痴呆的证候要素与玄府病机[J].北京中医药大学学报,2006,29(10):665-666.
[15]杨辰华,王永炎.血管性痴呆的中医病机及辨治思路[J].中医研究,2005,18(5):6-7.
[16]王永炎.关于提高脑血管疾病疗效难点的思考[J].中国中西医结合杂志,1997,17(4):195-196.
[17]卫振华.血管性痴呆病因病机初探[J].山西中医,2005,21(6):1-2.
[18]刘恒,田金洲,燕莉等.血管性痴呆患者症候学研究[J].北京中医药大学学报,2006,29(1):52-55.
[19]张伯礼,王永炎,宫涛等.血管性痴呆的分期证治[J]中医中药学会内科脑病专业委员会第七次学术研讨会(广州)论文汇编,2001,5(6):10-13.
[20]邓振明等.中风痴呆病[J].中国医药学报,1991,6(3):13.
[21]谢颖桢.血管性痴呆的证候观察分析[J].北京中医药大学学报,1999,22(2):37.
[22]宫洪涛.肾精亏虚是血管性痴呆发生的根本[J].浙江中医杂志,2005,11(8):470-472.
[23]张伯礼,王永炎,陈汝兴,等.健脑益智颗粒治疗血管性痴呆的随机双盲临床研究[J].中国中西医结合杂志,2002,22(8):577-579.
[24]王树国.填髓祛邪合剂治疗血管性痴呆54例[J].山西中医,2007,23(4):19-20.
[25]杨湘江.补肾活血汤加减治疗血管性痴呆的临床研究[J].广州中医药大学学 报,2005,22(6):426-428.
[26]张敏.六味地黄汤治疗血管性痴呆36例[J].陕西中医,2001,22(2):85.
[27]江翠红.脑复聪胶囊治疗血管性痴呆的临床研究[J].中西医结合心脑血管病杂志,2007,5(5):396-398.
[28]蔡晶.欣康胶囊对血管性痴呆患者血浆同型半胱氨酸及 B 淀粉样蛋白的影响[J].中国中西医结合杂志,2003,23(9):664-667.
[29]刘锡棐.康欣胶囊治疗老年肾虚型血管性痴呆的临床观察[J].南京中医学院学报,2007,23(3):148-151.
[30]王永炎,张伯礼.血管性痴呆现代临床与研究[M].北京:人民卫生出版社,2003,1:346
[31]王静,热孜万.痰瘀同治治疗血管性痴呆[J].新疆中医药,2005,23(5):3-4.
[32]郎黎红.清痴汤治疗血管性痴呆80例[J].浙江中西医结合杂志,2006,16(1):50-1.
[33]李辰佳.中西医结合治疗血管性痴呆临床观察[J].浙江中西医结合杂志,2003,13(8):502-503.
[34]周建英.益气复智颗粒治疗血管性痴呆的临床研究[J].上海中医药杂志,2005,39(3):11-13.
[35]周文强.健脑合剂治疗血管性痴呆38例及对临床电生理和循环动力学影响的临床研究[J].新中医,2002,34(11):21-23.
[3]郭增元.启智汤治疗血管性痴呆38例[J].内蒙古中医药,2001,20(4):10.
[37]张文才.解语丹加味治疗血管性痴呆96例[J].国医论坛,2002,17(1):39.
[38]刘传珍.通窍活血汤合补阳还五汤治疗血管性痴呆的临床研究[J].中医杂志,2002,43(7):526-527.
[39]张燕.祛痰化瘀益脑开窍法治疗血管性痴呆66例临床观察[J].河南中医,2003,23(5):26.
[40]朱振锋,刘瑞霞.老年呆病从肝论治[J].山东中医杂志,1996,15(11):483-484.
[41]李冰.血管性痴呆从肝论治[J].河北中医,2005,27(12):950.
[42]杜贵友,朱新成,赵建军,等.天智颗粒治疗老年血管性痴呆临床观察[J].中国中药杂志,2003,28(1):73-77.
[43]常富业,王永炎,高颖,等.病络机制与痴呆证治述要[J].中医研究,2006,18(5)1-3.
[44]任绪东,蔡华.血管性痴呆从络病辨证[J].黑龙江中医药,2006;1:25-6.
[45]任绪东,亓慧敏,蔡华.血管性痴呆从络病辨证[J].黑龙江中医药,2006,1:25-26.
[46]杨辰华,王永炎,王新志.血管性痴呆的证候要素与玄府病机[J].北京中医药大学学报.2006.29(10):665-666.
[47]刘方,白文.清开灵注射液治疗脑血管性痴呆32例[J].北京中医药大学学报(中医临床版),2004,11(1):21-23.
[48]孙明杰,于友华.清热解毒中药防治老年性痴呆症之理论探讨[J].中国中医基础医学杂志,2003,9(2):97-98.
[49]朱风梅,孙国强.清开灵注射液治疗血管性痴呆46例[J].临床荟萃,2003,18(23):1352-1353.
[50]谢颖桢,高颖,邹忆怀,等.血管性痴呆分期辨证及综合治疗的探讨[J].北京中医药大学学报,2001,24(3):3-5.
[51]宫洪涛,任德启,郭会军.郑绍周论治血管性痴呆的经验[J].专家传经,2002,2(6):187.
[52]宋颖民,王治国,郭清华.脑血管性痴呆的治疗体会[J].陕西中医,2004,25(10):959-960.
[53]李钰兰,郭宏敏.血管性痴呆的五脏论治[J].辽宁中医药大学学报,2008,10(1):30-31.
[54]苏国良,洪勇,赵勇.益气聪明汤加味治疗血管性痴呆临床观察[J].中国中医急症,2006,15(8):814-815.
[1]王湛涛.1663例脑血管意外病例分析.实用医技杂志,2006,13(6):1019-1020.
[2]Hoffmann M,Schmitt F.Cognitive impairment in isolated subtentorial stroke.Ac ta Neutrol Scand,2004,109(1):14-24.
[3]Beinhoff U,Hilbert V,Bittner D,et al.Screening for cognitive impairme nt:a triage for outpatient care.Dement Geriatr Cogn Disord,2005,20(5):278-285
[4]DeCarli C.Mild Cognitive impairment:prevalence,prognosis,aetiology and treat ment Lancet Neurol,2003,3(1):15-21.
[5]Bennett DA,Schneider JA,Bi enias JL,et al.Mild cognitive impairment is related to Alzhei mer disease pathology and cerebral infarctions.Neurology,2005,64(5):834-841.
[6]Bowler JV.The concept of vascular cognitive impairment.J Neurol Sci,2002,(203-204):11-15.
[7]Erkinjuntti T,Roc kwood K.Vascular dementia.Semin Clin Neuropsy Chiatry sci,2003,8(1):37-45.
[8]Kalaria RN,Kenny RA,Ballard CG,etal.Towards defining the neuropath Ological substrates of vascular dementia.J Neurol Sci,2004,226(1-2):75-80.
[9]Srikanth VK,Quinn SJ,Donnan GA,et al.Long-term cognitive ransitions,rates of cognitive change and predictors of incident dementia in a population-based first-ever stroke cohort.Stroke,2006,37(10):2479-2483.
[10]孟家眉,孟深,杨培洁,等.多发性脑梗塞患者智能障碍与病变关系的研究.中华内科杂志,1994,33(5):322-32.
[11]Moke VC,Wong a,La m WW,et al.Cognitive impairment and functional outco me after stroke associated with small vessel disease.J Neurol Neuroeurg Psyc hiat ry,2004,75(4):560-566.
[12]刘晓林,路屺,李强,等.脑卒中后血管性认知功能损害的临床观察.解剖与临床,2005,10(3):222-22.
[13]O'Brien JT,Erkinjuntti T,Reisberg B,et al.Vascular Cognitive i mpair ment.Lan cet Neurol,2003,21(2):89-98.
[14]中华医学会全国第四届脑血管病学术会议.各类脑血管病疾病诊断要点.中华经科杂志,1996,29(6):379.
[15]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行).北京中医药大学学报,1996,19(1):55-56.
[16]国家中医药管理局脑病急症科研组.中风病辨证诊断标准(试行),北京中医药大学学报,1991,17(3):64-66.
[17]Sacco RL foulkers MA Mohr JP.et al.Determi nant s of early recurrence of cerebral infarction.The stroke data bank.stroke 1989,20:983-989.
[18]Goldstein LB,Bartels C,Davis JN.Inter rater reliability of the NIH stroke scal e.A rch Neurol,1989,3(46):660-662.
[19]Folstein MF,Folstein SE,McHugh PR.“Mini-mental state exa m”:a practical method for grading the mental state patients for the clinician.Psychiatr Res,1975,12(4):189.
[20]Nasreddine ZS,Phillips NA,B(?)dirian V,Charbonneau S,Wh itehead V,CollinI,Cu mmings JL,Chertkow H.The Montreal Cognitive Assess ment(MoCA):A Brief Screening Tool For Mild Cognitive Impairment.J Am Geriatr Soc,53:695-699,2005.
[21]Nasreddine ZS,Chertkow H,Phillips N,Whitehead V,Collin I,Cummings JL.The Montreal Cognitive Assessment(MoCA):a Brief Cognitive Sc reening Tool for Detection of Mild Cognitive Impair ment.Neurology Vol 62 No 7 S(5) April 2004A132.Presented at the American Academy of Neurology Meeting,San Francisco,May 2004.
[22]Nasreddine ZS,Chertkow H,Phillips N,Whitehead V,Berg man H,Collin I,Cum mings JL,H(?)bert L.The Montreal Cognitive Assessment(MoCA):a Brief Cognitive Screening Tool for Detection of Mild Cognitive Impairment.Presented at the 8t h International Montreal/Springfield Symposium on Advances in AlzheimerTherapy.http://www.sium ed.edu /cme/AlzB rochure 04.pdf p.90,April 14-17,2004.
[23]Hughe s CP,berg L,Danziger WL,et al.A new clinical scale for the staging of dem entia.Br J Psychiatry,1982,140(3):566-572.
[24]张明园.精神科评定量表手册.湖南科学技术出版社,1993:122.