成人烟雾病患者认知功能的长期研究OA北大核心CSTPCD

Objective To assess the cognitive function of adult patients with Moyamoya disease(MMD)and the changes during long-term follow-up,and to explore the influencing factors of cognitive decline in adult patients with MMD. Methods A prospective cohort study was used to continuously include 64 adult patients with MMD admitted to the First Affiliated Hospital of Naval Medical University from January 2015 to June 2016,of whom 42 patients underwent revascularization(16 patients underwent combined revascularization and 26 patients underwent indirect revascularization),and 22 patients did not receive surgical treatment.Baseline characteristics of all patients were collected,and cognitive function was assessed by the MoCA at baseline,short-term[(6±1)months]follow-up,and long-term[(10±1)years]follow-up.Emotional status was assessed by patient health questionnaire-9(PHQ-9)and generalized anxiety disorder-7-item(GAD-7).The changes in cognitive function and emotional status were analyzed in all patients,as well as in patients receiving different treatment approaches,during short-and long-term follow-ups.The reliable change index(RCI)was used to determine whether there was a decline in function with the following formula:RCIMoCA=(X2-X1)/standard deviation(SD).It was defined as cognitive decline when RCIMoCA＜-1.The binary logistic regression model was used to explore the independent influencing factors of long-term cognitive decline in adult patients with MMD. Results A total of 53 patients completed the long-term follow-up,including 13 patients who underwent combined revascularization,22 patients who underwent indirect revascularization,and 18 patients who did not undergo surgery.The MoCA scores of the overall population tended to stabilize during the long-term follow-up period(P=0.694).Patients who underwent combined revascularization[21(18-25)points vs.19(17-24)points,P=0.035]and indirect revascularization[20(17-22)points vs.19(16-22)points,P=0.047]showed improvement in MoCA scores at short-term follow-up,but tended to stabilize relative to baseline at long-term follow-up.There was no significant decrease in MoCA scores in patients who did not undergo surgery at short-term follow-up,but there was a decrease in MoCA scores compared with baseline at long-term follow-up[15(11-24)points vs.18(14-26)points,P=0.039].Over time,the cognitive function of adult patients with MMD tended to worsen,while the anxiety and depression status tended to improve.There was a significant difference in the proportion of surgical treatment between the two groups with and without cognitive decline during the long-term follow-up(P=0.037),but logistic regression did not find it as an independent influencing factor(P＞0.05). Conclusions During long-term follow-up,the cognitive function of adult patients with MMD generally remain stable,and the anxiety and depression status tends to improve.Revascularization may have a positive effect on maintaining long-term cognitive stability,and future studies with larger sample sizes are needed.