BackgroundThe hemoglobin glycation index (HGI) effectively captures individual variations in glycation, its association with cognitive impairment remains unclear.ObjectiveThe purpose of this study was to investigate the relationship between HGI and cognitive impairment risk in the Chinese population.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015 were analyzed. Cognitive function was assessed using the American Health and Retirement Study's methodology, which included episodic memory and mental status. Multivariate Cox proportional hazards models and restricted cubic splines were used to examine the link between HGI and the likelihood of cognitive impairment, specific cognitive domains included. Moreover, the potential inflection points were investigated using saturation threshold effect analysis, with bootstrap resampling applied for internal validation.ResultsA U-shaped relationship was observed between HGI and the risk of cognitive impairment, as demonstrated by the restricted cubic spline analysis (p for non-linearity <0.001). The primary analysis identified an inflection point at approximately 0.085. Internal validation via bootstrapping yielded a 95% empirical confidence interval of 0.013 to 0.255 for this point. Conversely, HGI levels above 0.085 resulted in a 70.6% increase in the hazard ratio of cognitive impairment (all p < 0.05).ConclusionsIn the Chinese population, our results point to a U-shaped association between HGI and the risk of cognitive impairment, suggesting that both very low and very high HGI levels raise the risk of cognitive impairment, especially execution and memory.

Abstract Background Inflammation and malnutrition are well-recognized contributors to adverse outcomes in patients with acute ischemic stroke (AIS). The advanced lung cancer inflammation index (ALI), a composite biomarker of inflammation and nutritional status that incorporates body mass index (BMI), albumin (ALB), and neutrophil-to-lymphocyte ratio (NLR), has demonstrated prognostic value in various clinical settings, but evidence in AIS remains limited. We aimed to evaluate the association between ALI and multiple adverse outcomes in patients with AIS and to compare its predictive performance with that of its individual components. Methods A multicenter prospective cohort study was conducted including 12,911 individuals with AIS from the Third China National Stroke Registry. Multivariable logistic and Cox proportional hazards regression analyses were used to estimate the association between ALI and all-cause mortality, combined vascular events (CVE), stroke recurrence, and poor functional outcome [modified Rankin Scale (mRS) score 3–6] at 3-month and 1-year follow-up. Non-linear relationships were investigated using restricted cubic splines (RCS). Predictive performance was assessed using receiver operating characteristic curves with DeLong’s test, and model calibration was evaluated using calibration curves. Results After adjustment for confounders, each IQR increase in ALI was associated with reduced risks of all-cause mortality (HR 0.61, 95% CI 0.52–0.72), poor functional outcome (OR 0.73, 95% CI 0.69–0.77), stroke recurrence (HR 0.87, 95% CI 0.82–0.93), and CVE (HR 0.87, 95% CI 0.82–0.93) at 3 months. Quartile-based analysis further demonstrated a dose–response relationship, with patients in the highest quartile showing the lowest risks (all P for trend < 0.0001). RCS analysis revealed approximately L-shaped nonlinear relationships. Furthermore, ALI demonstrated superior predictive value for all-cause mortality (AUC = 0.736) and poor functional outcome (AUC = 0.666) compared to BMI, ALB, and NLR (all P < 0.005), with good calibration. Similar results were observed at 1 year. Conclusions Higher baseline ALI was independently associated with reduced risks of all-cause mortality, poor functional outcome, CVE, and recurrence in patients with AIS. ALI demonstrated moderate to good predictive value with good calibration for mortality and poor functional outcome, whereas its discriminative ability for stroke recurrence and CVE was limited. Further validation in diverse populations and evaluation of incremental predictive value are warranted. Clinical trial number Not applicable.

Objective: To investigate the association between acute-phase gait speed and health-related quality of life (HRQoL) at 3 and 12 months post-stroke. Design: Prospective cohort study. Subjects/Patients: 1,475 patients with first-ever ischaemic stroke. Methods: The patients were divided into 3 groups according to tertiles of gait speed, namely ≤0.8, 0.8–1.1, ≥1.1 m/s. Gait speed was assessed by the 10-m walking test within 2 weeks of hospitalization for acute stroke and before the rehabilitation programme. HRQoL measurements include the 3-level EuroQol five dimensions (EQ-5D-3L) index and EuroQoL visual analogue scale (EQ-VAS) scores. Linear and logistic regression analyses were used to identify associations between gait speed and HRQoL. Results: Adjusted for all covariates, the highest gait speed tertile group were associated with higher EQ-5D-3L index (B = 0.0303 and B = 0.0228, respectively, p < 0.001), and higher EQ-VAS (B = 3.3038 and B = 3.8877, respectively, p < 0.001), and lower odds of having problems with mobility (OR = 2.55 [95% CI: 0.141–0.458] and 0.485 [0.289–0.812], respectively, p < 0.01), self-care (OR = 0.328 [95% CI: 0.167–0.646] and 0.412 [0.217–0.784], respectively, p < 0.01), and usual activities (OR = 0.353 [95% CI: 0.211–0.590] and 0.325 [0.198–0.536], respectively, p < 0.0001) at 3 and 12 months, and pain/discomfort at 12 months (OR = 0.558 [95% CI:0.335–0.930], p < 0.05). Conclusion: Acute-phase gait speed was predictive of post-stroke HRQoL at 3 and 12 months, especially when associated with domain-specific EQ-5D-3L.

目的 探讨虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响.方法 2021年1-6月前瞻性连续选择符合入排标准的缺血性卒中患者,采用随机数字表法将患者随机分成试验组和对照组.对照组进行常规康复训练,试验组在常规康复训练基础上联合虚拟现实跑台训练.康复治疗前和治疗4周后由同一名评估者采用NIHSS、Fugl-Meyer运动功能评定量表(Fugl-Meyer motor assessment,FMA)、Berg平衡量表(Berg balance scale,BBS)、6?min步行试验(6-minute walking test,6MWT)、功能性步态评价(functional gait assessment,FGA)、改良巴氏指数(modified Barthel index,MBI)对患者进行肢体运动功能、平衡功能、步行能力及日常生活能力的评定.结果 共纳入53例患者,试验组27例,对照组26例.治疗前,两组患者NIHSS、FMA、BBS、6MWT、FGA、MBI评分差异均无统计学意义.经过4周治疗,试验组、对照组患者NIHSS评分均较治疗前降低,FMA、BBS、6MWT、FGA、MBI评分均较治疗前明显提高,差异均有统计学意义(P<0.05).干预4周后,试验组FMA评分[93.0(83.0～100.0)分vs.?82.5(68.0～94.0)分,P=0.020]和FGA评分[19.0(13.0～22.0)分vs.?14.0(8.8～17.3)分,P=0.048]均高于对照组,但NIHSS、BBS、6MWT、MBI评分与对照组差异无统计学意义(P>0.05).结论 虚拟现实跑台训练可提高缺血性卒中患者运动能力、平衡功能、步行能力及日常生活活动能力.与常规康复训练相比,虚拟现实跑台在提高缺血性卒中患者运动能力和步行能力方面更有效.

目的 观察脑卒中患者肺功能的变化.方法 选取2021年5月至2022年1月首都医科大学附属北京天坛医院收治的30例脑卒中患者为试验组,另择本院同期招募的27例正常人作为对照组.比较分析两组的慢肺活量指标[深吸气量(inspiratory capacity,IC)占预计值的百分比,补呼气量(expiratory reserve volume,ERV)占预计值的百分比,补吸气量(inspiratory reserve volume,IRV),平静时的潮气量(tidal volume,VT)]、用力肺活量指标[用力肺活量(forced vital capacity,FVC)占预计值的百分比,一秒用力呼气量(forced expiratory volume in the first second,FEV1)占预计值的百分比,FEV1/FVC,峰值呼气流速(peak expiratory flow,PEF)占预计值的百分比]和最大通气量指标[最大分钟通气量(maximal voluntary ventilation,MVV)占预计值的百分比,最大通气量时的VT,呼吸频率(breath frequency,BF)].结果 两组的ERV占预计值的百分比、平静状态下的VT和BF比较差异均无显著性(P>0.05);对照组的IC占预计值的百分比、IRV、FVC占预计值的百分比、FEV1占预计值的百分比、PEF占预计值的百分比、FEV1/FVC、MVV占预计值的百分比和最大通气量时的VT均显著优于试验组(P<0.05).结论 脑卒中患者的肺功能显著下降.

目的 探讨不同时间康复介入对卒中患者运动功能康复的影响.方法 选取2021年1月-2022年2月首都医科大学附属北京天坛医院康复医学科、北京市中关村医院康复医学科和神经内科符合入排标准的卒中患者,按照康复介入时间将患者分为早期康复组和延迟康复组.早期康复组的患者病情稳定后,发病7 d内立即开始进行康复训练,延迟康复组的患者病情稳定后,发病30 d以上开始进行康复训练.康复治疗前、治疗1个月±7天和治疗3个月±7天时由同一名评估者采用NIHSS、Fugl-Meyer运动功能评定(Fugl-Meyer motor assessment,FMA)量表、Berg平衡量表(Berg balance scale,BBS)、6分钟步行试验(6 minute walking test,6MWT)、功能性步态评价(functional gait assessment,FGA)、改良巴氏指数(modified Barthel index,MBI)对两组患者的神经功能、运动功能、平衡能力、步行能力及日常生活能力进行评定.结果 共纳入70例患者,其中早期康复组35例,延迟康复组35例.治疗前,两组患者NIHSS、FMA、BBS、6MWT、FGA、MBI评分差异均无统计学意义.在治疗1个月±7天和3个月±7天,两组患者NIHSS较治疗前降低,FMA、BBS、6MWT、FGA和MBI评分均较治疗前提高,差异均有统计学意义(P<0.05).康复治疗1个月±7天时,早期康复组NIHSS低于延迟康复组[1.0(0～2.0)分vs.2.0(0～6.0)分,P=0.030],6MWT高于延迟康复组[200.0(80.0～300.0)m vs.150.0(0～230.0)m,P=0.040],FMA、BBS、FGA及MBI评分差异无统计学意义(P>0.05).康复治疗3个月±7天时,早期康复组NIHSS低于延迟康复组[0(0～0)分vs.1.0(0～4.0)分,P=0.001],BBS评分[54.0(49.0～56.0)分vs.49.0(33.0～54.0)分,P=0.013]、6MWT[320.0(200.0～430.0)m vs.210.0(80.0～360.0)m,P=0.009]、FGA评分[22.0(15.0～28.0)分vs.15.0(5.0～24.0)分,P=0.015]、MBI评分[100.0(95.0～100.0)分vs.90.0(70.0～100.0)分,P=0.003]均高于延迟康复组,FMA评分差异无统计学意义(P=0.053).结论 康复训练可以改善卒中患者的运动功能,早期康复与延迟康复相比,早期康复治疗的介入对卒中患者的神经功能缺损程度、平衡能力、步行能力及日常生活能力的提高更显著.

脑卒中是世界上致残率最高的疾病,脑卒中后可导致一系列并发症的发生,从而严重影响患者的生活质量.据统计,75％的脑卒中患者存在上肢功能障碍,50％～80％的脑卒中患者可出现吞咽功能障碍,53.4％的患者在脑卒中发生后的1年半仍存在认知功能障碍 [1-2].康复治疗虽然可以在一定程度上改善脑卒中患者的预后,但仍有15％～30％的患者会存在永久残疾 [3].康复治疗从物理治疗起步,在不断发展中合并新的工程科技技术和理念,并融入工程、电子、心理学等多方面,现已发展到目前的智能康复,为无数脑卒中患者带来了新的希望.

路易体痴呆(dementia with Lewy bodies,DLB)是一种神经变性性痴呆,以细胞内路易体(Lewy bodies,LB)沉积为病理特点,临床表现为波动性认知功能障碍、视幻觉和帕金森综合征.这一疾病由Lewy等[1]于1912年首次报道.由于帕金森病(Parkinson disease,PD)患者晚期可发展为帕金森病痴呆(Parkinson's disease with dementia,PDD),且PDD患者中脑内也存在LB,故区别二者十分困难.有学者制定了1年原则,即若患者发生痴呆在锥体外系症状1年后则倾向于诊断为PDD,反之,痴呆发生于锥体外系症状前或者后1年内则倾向于诊断为DLB[2].近期也有学者提出DLB与PDD是同种疾病的不同进展形式[3].此外,有研究在DLB患者发现老年斑(senile plaque,SP)和神经元纤维缠结(neurofibrillary tangles,NFT)沉积,提示DLB与阿尔兹海默病(Alzheimer disease,AD)存在相似性和联系[4].

目的 探讨双任务步行(dual-task walking,DTW)对缺血性卒中患者步态参数的影响.方法 前瞻性入组2020年6月-2021年3月于首都医科大学附属北京天坛医院康复科住院的缺血性卒中患者.选择时钟任务作为DTW中的认知任务,受试者依次完成单任务步行(single-task walking,STW)和DTW.使用Codamotion三维动作捕捉系统采集患者执行任务时步态的运动学参数(膝关节、踝关节活动范围、最大屈膝角度、最大伸膝角度、最大踝背屈角度、最大踝跖屈角度)和时空参数(步速、跨步长、跨步时间、跨步速度、步长、步长时间、步频、支撑期百分比),计算时空参数的变异系数.比较患者进行STW和DTW时上述步态参数的差异.结果 本研究共纳入28例缺血性卒中患者,男性20例(71.4％).患者进行STW和DTW时步态的运动学参数差异无统计学意义.在时空参数方面,与STW时相比,进行DTW时患者的步速降低(0.69±0.23?m/s?vs?0.80±0.27?m/s,P<0.001)、步长(0.41±0.11?m?vs?0.46±0.12?m,P<0.001)和跨步长缩短(0.85±0.20?m?vs?0.95±0.22?m,P<0.001).在时空参数变异性方面,与STW比较,卒中患者进行DTW时步长时间变异性[4.47(2.98～7.34)vs?2.58(1.76～4.27),P=0.013]及步频变异性[4.59(2.78～7.78)vs?2.71(1.84～4.44),P=0.020]增加.结论 卒中患者在进行DTW时更容易发现步态问题.与STW相比,双任务条件下的步态评估可能是更有效的卒中康复评估指标,也更适用于卒中后康复训练计划.

目的探讨缺血性卒中患者和健康人在进行双任务步行（dual-taskwalking,DTW）时,不同认知任务对步态和认知-运动干扰（cognitive-motor interference,CMI）的影响。方法选取24例急性缺血性卒中患者为卒中组,并选取与卒中组性别、年龄、受教育程度相匹配的16例健康志愿者为对照组。所有被试者依次完成坐姿下两项认知单任务（single-task,ST）,包括连续减法任务（serial subtraction,SS）和单词生成任务（word list generation,WLG）。然后完成单任务步行（single-taskwalking,STW）、连续减法时双重任务步行（SS-DTW）和单词生成时双重任务步行（WLGDTW）。使用Codamotion三维动作捕捉系统采集步态参数,包括步速、步频、跨步长和跨步时间,记录认知任务正确反应数量。比较两组在DTW时步行和认知任务的双重任务成本差异。结果 （1）在STW和两种DTW时,卒中组步速、跨步长和步频明显低于对照组,跨步时间长于对照组,差异有统计学意义（P＜0.05）。与STW相比,卒中组在不同DTW时步速降低、步频减慢且跨步时间延长,在SS-DTW时跨步长变短,差异有统计学意义（P＜0.05）;对照组在不同DTW时步速降低、步频减慢、跨步长变短和跨步时间延长,差异有统计学意义（P＜0.05）。（2）与认知ST相比,卒中组在两种DTW中,认知任务正确次数均减少（P＜0.05）;对照组仅在SS-DTW时,认知任务正确次数减少,差异有统计学意义（P＜0.05）。结论执行双重任务（dual-task,DT）会导致缺血性卒中患者和健康者步态表现下降,卒中患者在DTW时更易出现步态障碍。工作记忆任务和语义记忆任务对步态的干扰程度是相似的。DTW更能反映日常生活活动能力,关于DTW时CMI模式的探索可为评估实际步行功能和DT训练效果提供理论依据。

目的 探究急性脑卒中患者入院时的血红蛋白(hemoglobin,Hb)含量与卒中后认知障碍(post-stroke cognitive impairment,PSCI)的相关性.方法 回顾性分析2018年10月至2020年10月首都医科大学附属北京天坛医院收治的197例急性脑卒中患者的临床资料,根据急性脑卒中患者3个月后是否出现PSCI分为认知功能障碍组(151例)和非认知功能障碍组(46例).记录两组患者的一般人口学特征,包括年龄、教育程度等;记录两组患者的实验室指标水平,包括Hb、同型半胱氨酸、高密度脂蛋白、低密度脂蛋白、尿酸、肌酐、糖化血红蛋白、空腹血糖、甘油三酯、胆固醇等;记录两组患者的高血压史、卒中家族史和神经系统损害程度等.分析急性脑卒中患者3个月后发生PSCI的独立性影响因素及入院时的Hb含量与急性脑卒中患者3个月后发生PSCI的相关性.结果 两组患者的高血压史、卒中家族史、入院时的美国国立卫生研究院卒中量表评分、入院时的改良Rankin量表评分、空腹血糖、糖化血红蛋白、同型半胱氨酸、高密度脂蛋白、低密度脂蛋白、甘油三酯、胆固醇和尿酸水平比较差异均无显著性(P>0.05);认知功能障碍组患者的年龄显著高于非认知功能障碍组(P<0.05),教育程度、Hb含量和肌酐水平均显著低于非认知功能障碍组(P<0.05).多因素logistic回归分析结果显示,在校正其他混杂因素后,入院时的Hb含量、年龄和教育程度是急性脑卒中患者3个月后发生PSCI的独立因素(P<0.05).Pearson相关性分析结果显示,入院时的Hb含量与急性脑卒中患者3个月后PSCI的发生呈正相关(r=0.267,P<0.001).结论 入院时的Hb含量是急性脑卒中患者3个月后发生PSCI的独立因素,且入院时的Hb含量越低,急性脑卒中患者3个月后发生PSCI的风险越高.

认知功能是人脑的高级皮质功能,主要包括语言、记忆功能、视空间功能、执行功能等多个认知功能领域.认知功能障碍是指其中一项或以上认知功能领域受损引起从轻度认知障碍到痴呆的一组综合征,在老年人群发病率较高[1].临床上最常见的痴呆亚型是阿尔茨海默病(AD)、血管性痴呆(VaD)、路易体痴呆和额颞叶痴呆.认知功能障碍严重影响患者的生活质量及社会功能,给家庭及社会造成了沉重的经济负担.根据流行病学数据显示,贫血在不同性别和年龄组的发病率在4.3％?26.0％,且随着年龄的增长,贫血的发病率随之增加[2].导致贫血的原因有多种,其中铁、维生素B12和叶酸缺乏引起的营养性贫血最常见.另外慢性肾功能衰竭、慢性感染性疾病、恶性肿瘤、遗传性和后天获得性溶血等引起的贫血在人群中也不罕见[3].

Background: Non-linguistic cognitive training has been suggested to improve the communication skills of patients with post-stroke aphasia (PSA). However, the association between language and non-linguistic cognitive functions is not fully understood. In this study, we used the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to evaluate the characteristics of non-linguistic cognitive impairments in Chinese PSA patients. Methods: A total of 86 stroke patients were recruited in this study. Language and non-linguistic cognitive impairments were evaluated by the Western Aphasia Battery (WAB) and LOTCA, respectively. The patients were divided into two groups (PSA and non-PSA), and the Chinese norm (the data came from 44 Chinese individuals without neurological disorders in a previous study) was used as the control group. The LOTCA scores were compared among the three groups. Patients in the PSA group were subdivided into the fluent aphasia group (FAG) and the non-FAG according to the Chinese aphasia fluency characteristic scale. The LOTCA scores were also compared between the PSA subdivisions. Potential confounders were adjusted in the analysis of covariance. Partial correlation analysis between the subscores of WAB and LOTCA was also performed. Results: The total LOTCA scores in the PSA group (75.11 ± 17.08) were significantly lower compared with scores in the non-PSA (96.80 ± 7.75, P < 0.001) and the control group (97.65 ± 16.24, P < 0.001). The PSA group also had lower orientation, visual perception (VP), spatial perception (SP), visuomotor organization, thinking operation, and attention scores. The total LOTCA, orientation, VP, SP, and MP scores were lower in the non-FAG (69.24 ± 18.06, 8.62 ± 5.09, 12.76 ± 2.47, 7.48 ± 3.01, and 9.62 ± 2.25, respectively) compared with the FAG (80.36 ± 14.07, 12.14 ± 3.99, 14.09 ± 1.93, 9.68 ± 3.01, 10.55 ± 1.63, respectively, P's < 0.05). The aphasia quotient was positively correlated with the total score of LOTCA and scores of orientation, VP, SP, and MP (r = 0.710, 0.744, 0.565, 0.597, and 0.616; P < 0.001). Conclusion: Compared with stroke patients without aphasia, patients with PSA often have more extensive and serious non-linguistic cognitive impairments. Patients with non-fluent aphasia often present with serious cognitive impairments than those with fluent aphasia, especially the impairments of orientation and SP. Non-linguistic cognitive impairments correlate with language impairments in aphasia.

脑卒中后幸存者回归家庭和社会生活，进行功能性步行时常需同时执行运动和认知双重任务。通常情况下，其中一项或两项任务的执行能力会下降，造成双重任务间的干扰，其相关机制尚不明确。目前，关于双重任务训练对改善脑卒中后步行和认知功能的相关研究较多。通过功能性磁共振成像(fMRI)和近红外脑功能成像技术(fNIRS)等神经影像学方法来探索双重任务的相关机制是研究热点之一。

目的 探讨脑卒中后交叉性失语的临床特点.方法 收集、分析首都医科大学附属北京天坛医院收治的5例交叉性失语患者的临床资料并进行文献复习.结果 3例患者为镜像失语,2例为非典型性失语.口语表达障碍有3例为非流利性失语,2例为流利性失语.5例均伴有认知功能障碍.结论 交叉性失语其发病机制可能与远隔效应有关,交叉性失语分为镜像失语及非典型性失语两类,其口语表达障碍主要为非流利性失语,常伴有认知功能障碍.

对于脑卒中后认知障碍患者,采用人工智能技术进行认知功能测评,可改善传统人工评定可能存在的主观误差,以及时间成本、人力成本过高等问题,测评结果更加真实客观,具有较高的效率和良好的可信度.本文重点阐述人工智能技术在脑卒中后认知障碍中的应用现状及未来的发展前景,进一步了解该项技术对脑卒中后认知障碍评定、治疗的作用.