Influencing factors analysis of cognitive function in patients with spinal cord injury

doi:10.3761/j.issn.0254-1769.2021.07.010

Abstract

Abstract:

Objective To construct a structural equation model of cognitive function of patients with spinal cord injury（SCI） and its influencing factors,and to analyze the path of action of each factor on the cognitive function of SCI patients,so as to provide a basis for targeted cognitive function intervention programs. Methods From October 2019 to November 2020,the convenience sampling method was adopted to include 357 patients with SCI from 8 tertiary hospitals in Anhui Province. The General Situation Questionnaire,the Montreal Congnitive Assessment,and Hamilton Depression Table,Self-Efficacy Rehabilitation Outcome Scale,Social Support Rating Scale,the Revised Piper Fatigtle Scale,Pittsburgh Sleep Index Scale were employed,and a structural equation model was used to analyze the path of action of each influencing factor. Results Depression,self-efficacy,fatigue,sleep,and social support all affect the cognitive function of patients through different pathways. Depression negatively affects cognitive function with the direct and indirect effects of -0.245 and -0.282 respectively;self-efficacy positively affects cognitive function with the direct and indirect effects of 0.503 and 0.012,respectively;fatigue negatively affects cognitive function with a direct effect of -0.131;sleep negatively affects cognitive function with the direct and indirect effects of -0.353 and -0.210,respectively;social support positively affects cognitive function with direct and indirect effects of 0.110 and 0.874,respectively. Conclusion The cognitive function of patients with SCI is affected by the interaction of multiple factors. Medical staff should pay attention to the evaluation of the patient’s cognitive function and its influencing factors in clinical work,and take effective measures to improve the patient’s cognitive function in time.

Key words: Spinal Cord Injury, Cognitive Function, Influencing Factors, Psychological Nursing

摘要：

目的通过构建结构方程模型分析各因素对脊髓损伤患者认知功能的影响路径。方法采用便利抽样法,于2019年10月—2020年11月选取安徽省8所三级甲等综合医院的357例脊髓损伤患者作为研究对象。采用一般情况调查问卷、长沙版蒙特利尔认知评估量表、汉密顿抑郁量表、康复锻炼自我效能量表、社会支持评定量表、Piper疲乏修订量表、匹兹堡睡眠指数量表对其进行调查,运用结构方程模型分析各影响因素的作用路径。结果抑郁程度、自我效能水平、疲乏程度、睡眠质量、社会支持程度通过不同路径对患者认知功能产生影响,其中抑郁程度负向影响认知功能,直接、间接效应分别为-0.245、-0.282;自我效能水平正向影响认知功能,直接、间接效应分别为0.503、0.012;疲乏程度负向影响认知功能,直接效应为-0.131;睡眠质量负向影响认知功能,直接、间接效应分别为-0.353、-0.210;社会支持程度正向影响认知功能,直接、间接效应分别为0.110、0.874。结论脊髓损伤患者认知功能受到多个因素的交互影响,医护人员在临床工作中需要重视对患者认知功能及其影响因素的评估,并及时针对影响因素采取有效措施以提高患者的认知功能。

关键词: 脊髓损伤, 认知功能, 影响因素, 心理护理

LIAO Chenxia,LI Lunlan,DAI Qing,LIU Jing,QI Jinmei,WANG Jing,GAO Xin,HUANG Hui,YUAN Haowei. Influencing factors analysis of cognitive function in patients with spinal cord injury[J]. Chinese Journal of Nursing, 2021, 56(7): 1015-1022.

廖晨霞,李伦兰,戴晴,刘静,祁金梅,汪晶,高馨,黄慧,袁昊炜. 脊髓损伤患者认知功能的影响因素分析[J]. 中华护理杂志, 2021, 56(7): 1015-1022.

Figures/Tables 7

Table 1 General information of the research objects（n=357）

Table 2 The scores of each dimension of Montreal Con-gnitive Assessment in patients with spinal cord injury

Table 3 Correlation analysis among influencing factors of cognitive function in patients with spinal cord injury（r value）

Table 4 Test result of fit degree of structural equation model（n=357）

Fig 1 Structural equation model diagram of factors affecting cognitive function in patients with spinal cord injury

Table 5 Path analysis of factors affecting cognitive function in patients with spinal cord injury

Table 6 Standardized effects of depression,self-efficacy, fatigue,sleep and social support on the cognitive function of patients with spinal cord injury

References 38

[1]	Ropper AE, Ropper AH. Acute spinal cord compression[J]. N Engl J Med, 2017, 376(14):1358-1369. DOI URL
[2]	Dudley-Javoroski S, Lee J, Shields RK. Cognitive function,quality of life,and aging:relationships in individuals with and without spinal cord injury[J]. Physiother Theory Pract, 2020:1-10.
[3]	Zonfrillo MR, Durbin DR, Winston FK, et al. Residual cognitive disability after completion of inpatient rehabilitation among injured children[J]. J Pediatr, 2014, 164(1):130-135. DOI URL
[4]	Cannon JA, Moffitt P, Perez-Moreno AC, et al. Cognitive impairment and heart failure:systematic review and meta-analysis[J]. J Card Fail, 2017, 23(6):464-475. DOI PMID
[5]	Tamura Y, Ishikawa J, Fujiwara Y, et al. Prevalence of frailty,cognitive impairment,and sarcopenia in outpatients with cardiometabolic disease in a frailty clinic[J]. BMC Geriatr, 2018, 18(1):264. DOI URL
[6]	Gorgoraptis N, Zaw-Linn J, Feeney C, et al. Cognitive impairment and health-related quality of life following traumatic brain injury[J]. Neuro Rehabil, 2019, 44(3):321-331.
[7]	Yusof Y, Mukari SZS, Dzulkifli MA, et al. Efficacy of a newly developed auditory-cognitive training system on speech recognition,central auditory processing and cognitive ability among older adults with normal cognition and with neurocognitive impairment[J]. Geriatr Gerontol Int, 2019, 19(8):768-773. DOI URL
[8]	Li XJ, Yang LL, Yin J, et al. Validation study of the Chinese version of addenbrooke’s cognitive examination III for diagnosing mild cognitive impairment and mild dementia[J]. J Clin Neurol, 2019, 15(3):313-320. DOI URL
[9]	Sachdeva R, Gao F, Chan CCH, et al. Cognitive function after spinal cord injury:a systematic review[J]. Neurology, 2018, 91(13):611-621. DOI PMID
[10]	Li Y, Ritzel RM, Khan N, et al. Delayed microglial depletion after spinal cord injury reduces chronic inflammation and neurodegeneration in the brain and improves neurological recovery in male mice[J]. Theranostics, 2020, 10(25):11376-11403. DOI URL
[11]	黄悦勤. 医学科研中随机误差控制和样本量确定[J]. 中国心理卫生杂志, 2015, 29(11):874-880.
	Hang YQ. Random error control and sample size determination in medical research[J]. Chin Ment Heal J, 2015, 29(11):874-880.
[12]	Chen YZ, Liang LK, Cao SN, et al. Serum CCL21 as a potential biomarker for cognitive impairment in spinal cord injury[J]. Biomed Res Int, 2020: 6692802.
[13]	涂秋云, 靳慧, 丁斌蓉, 等. 长沙版蒙特利尔认知评估量表的信度、效度检测与血管性认知障碍理想划界分值[J]. 中国神经精神疾病杂志, 2012, 38(6):339-345.
	Tu QY, Jin H, Ding BR, et al. The study on reliability,validity of Montreal Cognitive Assessment(Changsha Version) and preliminary exploration of its optimal cutoff score for detecting vascular cognitive impairment[J]. Chin J Nerv Ment Dis, 2012, 38(6):339-345.
[14]	Culpepper-Morgan JA, Twist DJ, Petrillo CR, et al. Beta-Endorphin and cortisol abnormalities in spinal cord-injured individuals[J]. Metabolism, 1992, 41(6):578-581. PMID
[15]	冯永林, 刘兰花, 韦春媛, 等. 感受焦虑抑郁的更年期居民汉密顿量表评定[J]. 上海精神医学, 2000, 12(2):94-95.
	Feng YL, Liu LH, Wei CY, et al. Evaluation of Hamilton Scale for menopausal residents feeling anxiety and depression[J]. Shanghai Arch Psychiatry, 2000, 12(2):94-95.
[16]	Stevens M, van den Akker-Scheek I, van Horn JR. A Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale(SER):a first impression on reliability and validity[J]. Patient Educ Couns, 2005, 58(2):121-126. PMID
[17]	Chmielewski TL, Zeppieri G Jr, Lentz TA, et al. Longitudinal changes in psychosocial factors and their association with knee pain and function after anterior cruciate ligament reconstruction[J]. Phys Ther, 2011, 91(9):1355-1366. DOI PMID
[18]	王海燕, 许燕玲, 胡三莲, 等. 中文版康复自我效能感量表的信效度评价[J]. 中华现代护理杂志, 2014, 20(3):268-270.
	Wang HY, Xu YL, Hu SL, et al. Evaluation of the reliability and validity of Chinese version self-efficacy for rehabilitation outcome scale[J]. Chin J Mod Nurs, 2014, 20(3):268-270.
[19]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2):98-100.
	Xiao SY. The theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychiat, 1994, 4(2):98-100.
[20]	李小金, 方海云, 王楚怀. 脊髓损伤患者的社会支持状况调查[J]. 中国临床康复, 2006, 10(18):17-19.
	Li XJ, Fang HY, Wang CH. Social support status in patients with spinal cord injury[J]. Chin J Clin Rehabil, 2006, 10(18):17-19.
[21]	Piper BF, Dibble SL, Dodd MJ, et al. The revised Piper Fatigue Scale:psychometric evaluation in women with breast cancer[J]. Oncol Nurs Forum, 1998, 25(4):677-684. PMID
[22]	Hahn EA, Magasi SR, Carlozzi NE, et al. Health and functional literacy in physical rehabilitation patients[J]. Health Lit Res Pract, 2017, 1(2):e71-e85.
[23]	So WKW, Dodgson J, Tai JWM. Fatigue and quality of life among Chinese patients with hematologic malignancy after bone marrow transplantation[J]. Cancer Nurs, 2003, 26(3):211-219. DOI URL
[24]	Hsieh SW, Lai CL, Liu CK, et al. Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea[J]. Qual Life Res, 2010, 19(9):1265-1272. DOI URL
[25]	刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2):103-107.
	Liu XC, Tang MQ, Hu L, et al. Reliability and validity of the Pittsburgh sleep quality index[J]. Chin J Psychiatry, 1996, 29(2):103-107.
[26]	陈肖敏, 金艾香, 朱慧, 等. 虚拟认知康复训练在乳腺癌化疗相关认知障碍患者中的应用[J]. 中华护理杂志, 2019, 54(5):664-668.
	Chen XM, Jin AX, Zhu H, et al. Application and effect of virtual cognitive rehabilitation training in breast cancer patients with cognitive impairment after chemotherapy[J]. Chin J Nurs, 2019, 54(5):664-668.
[27]	王晓蕾, 许燕玲, 黄晓莉, 等. 稳定性冠状动脉心脏病患者心绞痛程度与其认知功能的相关性研究[J]. 解放军护理杂志, 2017, 34(4):26-30.
	Wang XL, Xu YL, Huang XL, et al. Study on the correlation between the angina pectoris severity and the cognitive function in patients with stable coronary artery disease[J]. Nurs J Chin PLA, 2017, 34(4):26-30.
[28]	魏月清, 李红, 李芸, 等. ICU后认知障碍风险预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(1):14-20.
	Wei YQ, Li H, Li Y, et al. Construction of a risk prediction model for post-intensive care syndrome-cognitive impairment[J]. Chin J Nurs, 2021, 56(1):14-20.
[29]	潘晶雪, 陈利群, 王敬丽, 等. 社区老年慢性病患者认知功能的现状调查[J]. 中华护理杂志, 2021, 56(1):109-115.
	Pan JX, Chen LQ, Wang JL, et al. Study on the status of cognitive function in community elderly adults with chronic diseases[J]. Chin J Nurs, 2021, 56(1):109-115.
[30]	Abu Bakar ZH, Damanhuri HA, Makpol S, et al. Effect of age on the protein profile of healthy Malay adults and its association with cognitive function competency[J]. J Alzheimers Dis, 2019, 70(s1):S43-S62. DOI URL
[31]	Alakus F, Helvaci SA, Temizel M, et al. A cross-sectional study to evaluate metabolic and demographic factors affecting cognitive function among low educated internal medicine outpatients[J]. Neurosciences(Riyadh), 2017, 22(1):38-43.
[32]	Distel DF, Amodeo M, Joshi S, et al. Cognitive dysfunction in persons with chronic spinal cord injuries[J]. Phys Med Rehabil Clin N Am, 2020, 31(3):345-368. DOI URL
[33]	Kang DH, Boss L, Clowtis L. Social support and cognition:early childhood versus older adulthood[J]. West J Nurs Res, 2016, 38(12):1639-1659. DOI URL
[34]	Williams R, Murray A. Prevalence of depression after spinal cord injury:a meta-analysis[J]. Arch Phys Med Rehabil, 2015, 96(1):133-140. DOI URL
[35]	Suciu BD, Micluȶia IV. Clinical quest for associated cognitive impairment in major depressed patients[J]. Psychiatr Q, 2020, 91(3):749-759. DOI URL
[36]	La Fleur CG, Salthouse TA. Which aspects of social support are associated with which cognitive abilities for which people[J]. J Gerontol B Psychol Sci Soc Sci, 2017, 72(6):1006-1016.
[37]	Aristotelous P, Stefanakis M, Pantzaris M, et al. Associations between functional capacity,isokinetic leg strength,sleep quality and cognitive function in multiple sclerosis patients:a cross-sectional study[J]. Postgrad Med, 2019, 131(7):453-460. DOI PMID
[38]	Varga AW, Wohlleber ME, Giménez S, et al. Reduced slow-wave sleep is associated with high cerebrospinal fluid Aβ42 levels in cognitively normal elderly[J]. Sleep, 2016, 39(11):2041-2048. DOI URL