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BRAIN and NERVE Volume 70, Issue 6 （June 2018）

BRAIN and NERVE 70巻6号（2018年6月発行）

Japanese English

原著

脳梗塞リハビリテーションの転帰に影響する脳卒中発症前認知機能障害の検討 Influence of Pre-existing Cognitive Impairment on Rehabilitation Outcomes in Patients with Cerebral Infarction 荒木有三 ¹ , 古市昌宏 ¹ , 野倉宏晃 ¹ , 岩田辰夫 ² Yuzo Araki ¹ , Masahiro Furuichi ¹ , Hiroaki Nokura ¹ , Tatsuo Iwata ² ¹社会医療法人志聖会総合犬山中央病院脳神経外科 ²社会医療法人志聖会総合犬山中央病院リハビリテーション科 ¹Department of Neurosurgery, General Inuyama Chuo Hospital ²Department of Rehabilitation, General Inuyama Chuo Hospital キーワード：脳卒中発症前認知機能障害 , 脳梗塞 , リハビリテーション , FIM , 3D-SSP , pre-existing cognitive impairment , cerebral infarction , rehabilitation , functional independence measure , three-dimensional stereotactic surface projection Keyword: 脳卒中発症前認知機能障害 , 脳梗塞 , リハビリテーション , FIM , 3D-SSP , pre-existing cognitive impairment , cerebral infarction , rehabilitation , functional independence measure , three-dimensional stereotactic surface projection pp.651-660

発行日 2018年6月1日 Published Date 2018/6/1

DOI https://doi.org/10.11477/mf.1416201058

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片側大脳半球脳梗塞52症例を，認知症の既往歴と脳卒中発症後の3D-SSP（three-dimensional stereotactic surface projection）脳血流低下画像に基づいて，脳卒中発症前の認知機能障害群と非認知機能障害群に分類し，脳梗塞リハビリテーションの転帰を比較検討した。退院時総FIM（functional independence measure）には年齢・NIHSS（National Institute of Health Stroke Scale）・MMSE（Mini-Mental State Examination）の3因子が有意に影響した（R²＝0.756）。退院時の認知ならびに運動FIMは認知機能障害群で有意に低値を示した。また，脳血流低下画像は，NIHSSが軽症の場合はMMSEと関連性が認められ（P＜0.05），脳卒中発症前の認知機能障害の評価における有用性が示唆された。

Abstract

Background and Purpose: The present study determined the effects of pre-existing cognitive impairment (PreCI) on the rehabilitation outcomes in patients with cerebral infarction. Methods: From June 2013 to August 2015, we classified 52 patients with unilateral cerebral hemispheric infarction into the PreCI and non-PreCI group based on three-dimensional stereotactic surface projection (3D-SSP) cerebral blood flow (CBF) decrease images and the past history of dementia. Furthermore we investigated the related clinical factors and functional independence measure (FIM). Results: 1. Multivariate analysis revealed that the most important factors that affect total FIM at discharge were age, National institutes of Health Stroke Scale (NIHSS) and the Mini-Mental State Examination (MMSE) (R²=0.756). 2. The mean CBF values (P＜0.05) were significantly associated with lesion volume, (P＜0.001, P＜0.05), the NIHSS score (P＜0.001, P＜0.01), the MMSE score (P＜0.001, P＜0.005), and total FIM (P＜0.005, P＜0.05) at discharge. 3. Both cognitive and motor FIM at discharge were significantly lower in the PreCI group (P＜0.005, P＜0.005). 4. The MMSE score of ZSAM abnormal group was significantly lower in the case of NIHSS score＜10 of lesion and non lesion sides. Conclusions: PreCI, age, and neurological severity, affected the outcomes of stroke rehabilitation Therefore, the diagnosis of PreCI is considered important for effective stroke rehabilitation.

(Received August 3, 2017; Accepted February 9, 2018; Published June 1, 2018)