目的:分析老年高血压患者认知功能障碍和抑郁发生的影响因素及其与衰弱的相关性.方法:以2019年1月至2020年3月,我院心血管内科收治的老年高血压患者100例为研究对象,根据患者是否发生认知功能障碍分为障碍组(n=32)和非障碍组(n=68),根据患者是否发生抑郁分为抑郁组(n=42)和非抑郁组(n=58).比较不同认知功能和抑郁状态患者的临床资料和衰弱情况,采用多因素Logistic分析老年高血压患者发生认知功能障碍和抑郁的危险因素,采用Spearman相关性分析对老年高血压患者认知功能和抑郁状态与衰弱的相关性进行分析.结果:经多因素Logistic回归分析显示,年龄≥80岁、耐力下降、多病共存为老年高血压患者发生认知功能障碍的危险因素(OR=12.782、5.496、4.993,P＜0.05),耐力下降、疲劳、自由活动下降为老年高血压患者抑郁的危险因素(OR=8.688、5.119、7.294,P＜0.05).相关性分析显示,老年高血压患者认知功能与耐力下降、疲劳、多病共存、体质量下降和自由活动度下降的发生率呈负相关关系(r=-0.267、-0.223、-0.249、-0.138、-0.159,P＜0.05),抑郁状态与耐力下降、疲劳、多病共存、体质量下降和自由活动度下降的发生率呈正相关关系(r=0.364、0.381、0.259、0.191、0.164、0.210,P＜0.05).结论:年龄较高、耐力下降、多病共存为老年高血压患者发生认知功能障碍的危险因素,耐力下降、疲劳、自由活动下降为老年高血压患者抑郁的危险因素,同时老年高血压患者认知功能与衰弱的发生率呈负相关关系,抑郁状态与衰弱的发生率呈正相关关系.

Objective:To investigate the relationship between cognitive function and white matter hyperintensity( WM H) in outpatients w ith cerebrovascular disease. Methods: Totally 356 outpatients w ith cerebrovascular disease w ere selected from the departments of psychology and neurology. The disease history w as collected and the cognitive function w as assessed w ith the M ini M ental Sate Examination( M M SE) and M ontreal Cognitive Assessment( M oCA). The M M SE score 24 w as defined as the suspected dementia,and the M oCA 26 w as defined as the presence of cognitive decline. According to the standard of Fazekas score,the patients w ere divided into non WM H group( Fazekas score = 0),mild WM H group( Fazekas score = 1),moderate and severe WM H group( Fazekas≥2). M ultivariate analysis w as used to explore the possible causes that affected cognitive function. Results: Totally 356 patients w ith cerebrovascular disease w ho met the inclusion criteria w ere recruited. Among them,65 patients( 18. 3%) w ere w ith large area damage of brain,8 cases( 2. 2%) w ere w ith mixed cerebrovascular disease( 2 of them w ere w ith possible amyloid cerebrovascular disease),107 cases( 30. 1%) w ere w ith asymptomatic cerebral infarction,and 28 cases( 7. 8%) w ere only w ith w hite matter hyperintensity(WM H). Totally 81 cases( 23. 4%) w ere w ith severe w hite matter hyperintensity. The M M SE total score w as 5- 30 in 353 subjects,and the average score w as( 25. 6 ± 3. 5). Among them,18. 1% got a score of 24,reached suspected dementia state. The M oCA total score w as 5- 28 in 347 subjects,and the average score w as( 19. 4 ± 3. 9). Among them,94. 5% w ith a scoreof 26 had a varying degree of cognitive impairment. After controlling for age and education,in the patients w ith cerebrovascular disease,the level of WM H w as negatively correlated w ith the total scores of M M SE and M oCA,and the M oCA subtests of visuospatial executive function,attention,and orientation( r =- 0. 14,- 0. 15,- 0. 11,- 0. 16,- 0. 18; Ps 0. 05). Conclusion: It suggests that the cognitive function in patients w ith cerebrovascular disease may be low er,and be closely associated w ith w hite matter hyperintensity.

Objective To observe the efficacy of Nimodipine on vascular cognitive impairment in a shortperiod treatment. Methods It was a prospective opened own control study.Sixty-four patients with cerebrovascular disease were recruited from outpatient of neurology department.On the basis of secondary prevention drugs,patients were given to oral Nimodipine 60-90 mg/d.The patients' cognitive functions have been assessed using the mini mental state examination(MMSE) and Montreal cognitive assessment(MoCA) before and after 12-24 weeks treatment. Results After treatment of Nimodipine.the performance record were significantly better than before,total scores of MMSE were 26.3±2.7 vs 25.6±2.9(P=0.039),MoCA were 20.5±4.6 vs 19.0±4.1(P=0.000),and the memory test of MoCA were significant better than before(1.8±1.7 vs 1.1±1.2,P=0.000). Conclusion Nimodipine may have some benefits for cognitive function in patients with cerebral vascular disease.