{"id":31018,"date":"2023-05-06T21:54:01","date_gmt":"2023-05-06T14:54:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31018"},"modified":"2023-05-06T21:54:01","modified_gmt":"2023-05-06T14:54:01","slug":"suy-giam-nhan-thuc-sau-dot-quy","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/suy-giam-nhan-thuc-sau-dot-quy\/","title":{"rendered":"Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5"},"content":{"rendered":"

Suy gi\u1ea3m nh\u1eadn th\u1ee9c th\u01b0\u1eddng g\u1eb7p sau \u0111\u1ed9t qu\u1ef5 v\u1edbi t\u1ef7 l\u1ec7 20% t\u1ea1i th\u1eddi \u0111i\u1ec3m 6 th\u00e1ng sau \u0111\u1ed9t qu\u1ef5<\/a>. Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 l\u00e0 t\u1ea5t c\u1ea3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c x\u1ea3y ra sau \u0111\u1ed9t qu\u1ef5 b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n l\u00e0 g\u00ec, c\u00f3 th\u1ec3 do nhi\u1ec1u qu\u00e1 tr\u00ecnh b\u1ec7nh sinh kh\u00e1c nhau. Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 l\u00e0 g\u00e1nh n\u1eb7ng cho b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi ch\u0103m s\u00f3c, nh\u01b0ng cho t\u1edbi nay ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb nh\u01b0 m\u1ed9t th\u1ec3 ri\u00eang bi\u1ec7t. B\u00e0i vi\u1ebft n\u00e0y c\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n, ph\u00f2ng ng\u1eeba, \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 t\u1eeb Khuy\u1ebfn c\u00e1o suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 c\u1ee7a H\u1ed9i \u0110\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u k\u1ebft h\u1ee3p v\u1edbi H\u1ed9i Th\u1ea7n kinh ch\u00e2u \u00c2u ESO \u2013 EAN 2021.<\/strong>
\nT\u1eeb kh\u00f3a: Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5, sa s\u00fat tr\u00ed tu\u1ec7 sau \u0111\u1ed9t qu\u1ef5, sa s\u00fat tr\u00ed tu\u1ec7 m\u1ea1ch m\u00e1u.<\/p>\n

\"Suy
Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5<\/figcaption><\/figure>\n

B\u00e0i vi\u1ebft “Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5” tr\u00edch ngu\u1ed3n t\u1eeb H\u1ed9i th\u1ea7n kinh h\u1ecdc Vi\u1ec7t Nam<\/strong><\/em><\/p>\n

Nguy\u1ec5n Th\u1ecb Ph\u01b0\u01a1ng Nga<\/strong><\/em>
\nTr\u01b0\u1edfng khoa Khoa N\u1ed9i Th\u1ea7n kinh, B\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t<\/em><\/p>\n

1. GI\u1edaI THI\u1ec6U<\/strong><\/h2>\n

C\u00f9ng v\u1edbi s\u1ef1 gia t\u0103ng d\u00e2n s\u1ed1 \u1edf nh\u00f3m ng\u01b0\u1eddi c\u00f3 tu\u1ed5i, sa s\u00fat tr\u00ed tu\u1ec7 (SSTT) tr\u1edf th\u00e0nh m\u1ed9t v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe ph\u1ed5 bi\u1ebfn \u1edf ch\u00e2u \u00c1. SSTT \u0111\u1eb7c bi\u1ec7t cao \u1edf ng\u01b0\u1eddi ch\u00e2u \u00c1, chi\u1ebfm 46% tr\u00ean 25 t\u1ec9 ng\u01b0\u1eddi SSTT tr\u00ean to\u00e0n th\u1ebf gi\u1edbi.
\nSSTT \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh m\u1ed9t s\u1ed1 th\u1ec3 d\u1ef1a theo nguy\u00ean nh\u00e2n. SSTT do c\u0103n nguy\u00ean m\u1ea1ch m\u00e1u, bao g\u1ed3m SSTT sau \u0111\u1ed9t qu\u1ef5 (\u0110Q) n\u00e3o (poststroke dementia), l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ee9ng h\u00e0ng th\u1ee9 hai sau b\u1ec7nh Alzheimer.
\nSSTT sau \u0110Q n\u00e3o \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 SSTT x\u1ea3y ra sau \u0110Q do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n g\u00ec. SSTT sau \u0110Q l\u00e0 m\u1ed9t th\u1ec3 c\u1ee7a SSTT m\u1ea1ch m\u00e1u. Suy gi\u1ea3m nh\u1eadn th\u1ee9c (SGNT) m\u1ea1ch m\u00e1u (Vascular Cognitive Impairment) g\u1ed3m m\u1ed9t nh\u00f3m c\u00e1c r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c do nguy\u00ean nh\u00e2n m\u1ea1ch m\u00e1u c\u00f3 hay kh\u00f4ng SSTT v\u00e0 c\u00f3 hay kh\u00f4ng c\u00f3 li\u00ean quan th\u1eddi gian v\u1edbi m\u1ed9t bi\u1ebfn c\u1ed1 \u0110Q tr\u00ean l\u00e2m s\u00e0ng. SGNT sau \u0110Q l\u00e0 t\u1ea5t c\u1ea3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c x\u1ea3y ra sau \u0110Q b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n l\u00e0 g\u00ec. Nh\u01b0 v\u1eady ph\u1ea1m vi c\u1ee7a kh\u00e1i ni\u1ec7m n\u00e0y r\u1ea5t r\u1ed9ng v\u00e0 c\u00f3 s\u1ef1 ch\u1ed3ng l\u1ea5p v\u1edbi c\u00e1c kh\u00e1i ni\u1ec7m tr\u00ean, trong \u0111\u00f3 SGNT sau \u0110Q c\u00f3 th\u1ec3 l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p SGNT m\u1ea1ch m\u00e1u c\u00f3 hay kh\u00f4ng c\u00f3 SSTT v\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p SGNT h\u1ed7n h\u1ee3p do m\u1ea1ch m\u00e1u k\u1ebft h\u1ee3p v\u1edbi nguy\u00ean nh\u00e2n kh\u00e1c v\u00e0 c\u1ea3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p SGNT do tho\u00e1i h\u00f3a th\u1ea7n kinh kh\u1edfi ph\u00e1t sau \u0110Q.
\nSGNT th\u01b0\u1eddng g\u1eb7p sau \u0110Q v\u00e0 c\u00f3 th\u1ec3 do nhi\u1ec1u qu\u00e1 tr\u00ecnh b\u1ec7nh sinh kh\u00e1c nhau, l\u00e0 g\u00e1nh n\u1eb7ng cho b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi ch\u0103m s\u00f3c, nh\u01b0ng cho t\u1edbi nay ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb nh\u01b0 m\u1ed9t th\u1ec3 ri\u00eang bi\u1ec7t. B\u00e0i vi\u1ebft n\u00e0y c\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n, ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 t\u1eeb Khuy\u1ebfn c\u00e1o ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau \u0111\u1ed9t qu\u1ef5 AHA\/ASA 2018 v\u00e0 khuy\u1ebfn c\u00e1o ESO \u2013 EAN 2021 d\u1ef1a tr\u00ean m\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho t\u1edbi nay.<\/p>\n

2. D\u1ecaCH T\u1ec4 H\u1eccC<\/strong><\/h2>\n

Nghi\u00ean c\u1ee9u The Oxford Vascular Study kh\u1ea3o s\u00e1t t\u1ef7 l\u1ec7 c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u tr\u00ean 92 728 c\u01b0 d\u00e2n v\u00f9ng Oxfordshire, n\u01b0\u1edbc Anh nh\u1eadn th\u1ea5y c\u00f3 2305 b\u1ec7nh nh\u00e2n b\u1ecb c\u01a1n tho\u00e1ng thi\u1ebfu m\u00e1u n\u00e3o ho\u1eb7c \u0111\u1ed9t qu\u1ef5 t\u1eeb 2002-2012, c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c theo d\u00f5i 5 n\u0103m ghi nh\u1eadn t\u1ef7 l\u1ec7 SSTT sau \u0110Q c\u00f3 li\u00ean quan \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 d\u1ef1a theo thang \u0111i\u1ec3m NIHSS l\u00fac nh\u1eadp vi\u1ec7n. T\u1ea1i th\u1eddi \u0111i\u1ec3m 1 n\u0103m sau bi\u1ebfn c\u1ed1, t\u1ef7 l\u1ec7 SSTT \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 n\u1eb7ng (NIHSS score >10), \u0111\u1ed9t qu\u1ef5 nh\u1eb9 (NIHSS score <3) v\u00e0 c\u01a1n tho\u00e1ng thi\u1ebfu m\u00e1u n\u00e3o l\u1ea7n l\u01b0\u1ee3t l\u00e0 34.4%, 8.2% v\u00e0 5.2%. Nghi\u00ean c\u1ee9u t\u1ea1i b\u1ec7nh vi\u1ec7n c\u1ee7a Nguy\u1ec5n T.P Nga v\u00e0 c\u1ed9ng s\u1ef1 cho t\u1ef7 l\u1ec7 SSTT sau \u0111\u1ed9t qu\u1ef5 l\u00e0 35,3%. T\u1ef7 l\u1ec7 n\u00e0y trong c\u00e1c nghi\u00ean c\u1ee9u t\u1ea1i c\u1ed9ng \u0111\u1ed3ng th\u01b0\u1eddng th\u1ea5p h\u01a1n (kho\u1ea3ng 30%) theo y v\u0103n. T\u1ef7 l\u1ec7 m\u1edbi m\u1eafc SGNT thay \u0111\u1ed5i theo th\u1eddi gian sau \u0111\u1ed9t qu\u1ef5. Trong n\u0103m \u0111\u1ea7u sau \u0111\u1ed9t qu\u1ef5, t\u1ef7 l\u1ec7 SSTT s\u1edbm th\u1ea5p nh\u1ea5t 12% (CI 95% 9,6\u201314,4%) \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 l\u1ea7n \u0111\u1ea7u v\u00e0 kh\u00f4ng c\u00f3 sa s\u00fat tr\u00ed tu\u1ec7 tr\u01b0\u1edbc \u0111\u1ed9t qu\u1ef5, v\u00e0 cao nh\u1ea5t 41,3% (CI 95% 29,6\u201353,1%) \u1edf b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t c\u00f3 sa s\u00fat tr\u00ed tu\u1ec7 tr\u01b0\u1edbc \u0111\u1ed9t qu\u1ef5. T\u1ef7 l\u1ec7 SSTT ban \u0111\u1ea7u t\u0103ng nhanh ch\u00f3ng sau \u0111\u1ed9t qu\u1ef5 \u0111\u1ebfn kho\u1ea3ng 20% t\u1ea1i th\u1eddi \u0111i\u1ec3m 3 \u2013 6 th\u00e1ng, nh\u01b0ng sau 1 n\u0103m t\u1ef7 l\u1ec7 m\u1edbi m\u1eafc t\u00edch l\u0169y t\u0103ng ch\u1eadm l\u1ea1i v\u00e0 t\u0103ng tuy\u1ebfn t\u00ednh 3,0% m\u1ed7i n\u0103m (CI 95% 1,3\u20134,7%). Sau m\u1ed7i l\u1ea7n \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t th\u00ec t\u1ef7 l\u1ec7 n\u00e0y l\u1ea1i t\u0103ng g\u00e2y di\u1ec5n ti\u1ebfn SGNT ki\u1ec3u b\u1eadc thang \u0111\u1eb7c tr\u01b0ng cho SSTT m\u1ea1ch m\u00e1u.<\/p>\n

3. B\u1ec6NH SINH C\u1ee6A SUY GI\u1ea2M NH\u1eacN TH\u1ee8C M\u1ea0CH M\u00c1U<\/strong><\/h2>\n

C\u00e1c b\u1ea5t th\u01b0\u1eddng ho\u1eb7c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o c\u00f3 li\u00ean quan v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng do m\u1ea1ch m\u00e1u \u1edf b\u1ec7nh nh\u00e2n SGNT m\u1ea1ch m\u00e1u. Trong \u0111\u00f3, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u l\u1edbn do x\u01a1 v\u1eefa, b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf v\u00e0 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o d\u1ea1ng b\u1ed9t (cerebral amyloid angiopathy). C\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u kh\u00e1c \u00edt g\u1eb7p h\u01a1n l\u00e0 vi\u00eam m\u1ea1ch, b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o di truy\u1ec1n tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng g\u00e2y nh\u1ed3i m\u00e1u d\u01b0\u1edbi v\u1ecf v\u00e0 b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng (CADASIL). C\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o g\u00e2y ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng do m\u1ea1ch m\u00e1u ch\u1ee7 y\u00eau l\u00e0 c\u00e1c nh\u1ed3i m\u00e1u n\u00e3o (bao g\u1ed3m nh\u1ed3i m\u00e1u \u0111\u1ed9ng m\u1ea1ch l\u1edbn, nh\u1ed3i m\u00e1u l\u1ed5 khuy\u1ebft, nh\u1ed3i m\u00e1u v\u00f9ng gi\u00e1p ranh), t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng v\u00e0 xu\u1ea5t huy\u1ebft n\u00e3o. C\u00e1c sang th\u01b0\u01a1ng n\u00e3o do b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o s\u1ebd g\u00e2y c\u00e1c th\u1ec3 l\u00e2m s\u00e0ng SGNT t\u01b0\u01a1ng \u1ee9ng. SSTT do nh\u1ed3i m\u00e1u \u0111a \u1ed5 \u0111\u1eb7c tr\u01b0ng b\u1edfi c\u00e1c \u1ed5 nh\u1ed3i m\u00e1u l\u1ed5 khuy\u1ebft, vi nh\u1ed3i m\u00e1u ho\u1eb7c nh\u1ed3i m\u00e1u nh\u1ecf ho\u1eb7c l\u1edbn v\u1ecf v\u00e0 d\u01b0\u1edbi v\u1ecf. Ng\u01b0\u1ee3c l\u1ea1i, SSTT do nh\u1ed3i m\u00e1u v\u00f9ng chi\u1ebfn l\u01b0\u1ee3c c\u00f3 th\u1ec3 do nh\u1ed3i m\u00e1u \u0111\u01a1n d\u1ed9c \u1edf c\u00e1c v\u00f9ng chi\u1ebfn l\u01b0\u1ee3c nh\u01b0 h\u1ea3i m\u00e3, h\u1ea1ch n\u1ec1n, \u0111\u1ed3i th\u1ecb, th\u00f9y tr\u00e1n trong, g\u1ed1i bao trong\u2026 B\u1ec7nh n\u00e3o d\u01b0\u1edbi v\u1ecf do c\u0103n nguy\u00ean m\u1ea1ch m\u00e1u bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng lan r\u1ed9ng do t\u1ed5n th\u01b0\u01a1ng m\u1ea5t myelin v\u00e0 s\u1ee3i tr\u1ee5c g\u00e2y ra b\u1edfi b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf v\u00e0 CADASIL. Th\u1ec3 b\u1ec7nh n\u00e3o d\u01b0\u1edbi v\u1ecf do c\u0103n nguy\u00ean m\u1ea1ch m\u00e1u l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t 40 \u2013 50%, k\u1ebf \u0111\u1ebfn l\u00e0 th\u1ec3 nh\u1ed3i m\u00e1u \u0111a \u1ed5 20 \u2013 40% v\u00e0 nh\u1ed3i m\u00e1u v\u00f9ng chi\u1ebfn l\u01b0\u1ee3c 10 \u2013 15%.<\/p>\n

4. \u0110\u1eb6C \u0110I\u1ec2M L\u00c2M S\u00c0NG V\u00c0 DI\u1ec4N TI\u1ebeN C\u1ee6A SUY GI\u1ea2M NH\u1eacN TH\u1ee8C SAU \u0110\u1ed8T QU\u1ef4<\/strong><\/h2>\n

Do \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh sinh \u0111a d\u1ea1ng n\u00ean c\u00e1c khi\u1ebfm khuy\u1ebft nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 r\u1ea5t \u0111a d\u1ea1ng t\u00f9y v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng v\u00e0 ki\u1ec3u kh\u1edfi ph\u00e1t c\u1ee7a \u0111\u1ed9t qu\u1ef5. Kh\u00e1c v\u1edbi b\u1ec7nh Alzheimer, SGNT bi\u1ec3u hi\u1ec7n n\u1ed5i b\u1eadt \u1edf c\u00e1c l\u0129nh v\u1ef1c nh\u1eadn th\u1ee9c nh\u01b0 gi\u1ea3m ch\u00fa \u00fd ph\u1ee9c t\u1ea1p (complex attention) v\u00e0 t\u1ed1c \u0111\u1ed9 x\u1eed l\u00fd th\u00f4ng tin, gi\u1ea3m ch\u1ee9c n\u0103ng \u0111i\u1ec1u h\u00e0nh th\u00f9y tr\u00e1n (frontal-executive function). Ngo\u00e0i ra c\u00e1c sang th\u01b0\u01a1ng m\u1ea1ch m\u00e1u th\u01b0\u1eddng g\u00e2y gi\u00e1n \u0111o\u1ea1n \u0111\u01b0\u1eddng d\u1eabn truy\u1ec1n v\u1ecf n\u00e3o-h\u1ec7 vi\u1ec1n v\u00e0 g\u00e2y r\u1ed1i lo\u1ea1n h\u00e0nh vi v\u00e0 c\u1ea3m x\u00fac \u0111i k\u00e8m. SGNT sau \u0111\u1ed9t qu\u1ef5 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn ki\u1ec3u di\u1ec5n ti\u1ebfn t\u1eebng n\u1ea5c v\u1edbi s\u1ef1 suy gi\u1ea3m \u0111\u1ed9t ng\u1ed9t ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c sau m\u1ed9t bi\u1ebfn c\u1ed1 \u0111\u1ed9t qu\u1ef5, sau \u0111\u00f3 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c c\u1ea3i thi\u1ec7n m\u1ed9t ph\u1ea7n ho\u1eb7c ho\u00e0n to\u00e0n th\u01b0\u1eddng trong v\u00f2ng 6 th\u00e1ng (t\u00f9y thu\u1ed9c m\u1ed9t ph\u1ea7n v\u00e0o vi\u1ec7c b\u1ec7nh nh\u00e2n c\u00f3 hay kh\u00f4ng k\u00e8m theo b\u1ec7nh l\u00fd tho\u00e1i h\u00f3a th\u1ea7n kinh g\u00e2y SGNT tr\u01b0\u1edbc \u0111\u1ed9t qu\u1ef5, nh\u01b0 b\u1ec7nh Alzheimer\u2026). Sau giai \u0111o\u1ea1n c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c \u0111\u00f3 th\u00ec ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c c\u00f3 th\u1ec3 \u1ed5n \u0111\u1ecbnh ho\u1eb7c ti\u1ebfp t\u1ee5c suy gi\u1ea3m t\u00f9y thu\u1ed9c v\u00e0o s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 ti\u1ebfp di\u1ec7n c\u1ee7a c\u00e1c qu\u00e1 tr\u00ecnh g\u00e2y tho\u00e1i h\u00f3a th\u1ea7n kinh ti\u00ean ph\u00e1t (nh\u01b0 b\u1ec7nh Alzheimer) ho\u1eb7c th\u1ee9 ph\u00e1t do b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o ho\u1eb7c c\u1ea3 hai. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u1ea3 hai qu\u00e1 tr\u00ecnh b\u1ec7nh sinh b\u1ec7nh Alzheimer v\u00e0 b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ti\u1ebfn tri\u1ec3n g\u00e2y SGNT n\u1eb7ng n\u1ec1 nh\u1ea5t sau \u0111\u1ed9t qu\u1ef5 (suy gi\u1ea3m nh\u1eadn th\u1ee9c h\u1ed7n h\u1ee3p). M\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 SGNT do b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf v\u1edbi c\u00e1c l\u1ed5 khuy\u1ebft v\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng c\u00f3 SGNT ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng li\u00ean quan v\u1ec1 th\u1eddi gian v\u1edbi m\u1ed9t bi\u1ebfn c\u1ed1 \u0111\u1ed9t qu\u1ef5 r\u00f5 r\u00e0ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

5. CH\u1ea8N \u0110O\u00c1N<\/strong><\/h2>\n

Do kh\u00f4ng c\u00f3 c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 do \u0111\u00f3 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c t\u1ea7m so\u00e1t SGNT tr\u00ean t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 nh\u1eb1m c\u1ea3i thi\u1ec7n ch\u0103m s\u00f3c \u0111\u1ed9t qu\u1ef5 l\u00e0 kh\u00f4ng ch\u1eafc ch\u1eafn, v\u00e0 vi\u1ec7c t\u1ea7m so\u00e1t SGNT d\u1ef1a v\u00e0o nh\u1eadn \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 l\u00e2m s\u00e0ng. Ch\u01b0a c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 khuy\u1ebfn c\u00e1o v\u1ec1 th\u1eddi \u0111i\u1ec3m v\u00e0 n\u1ed9i dung \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c nh\u01b0ng c\u00e1c chuy\u00ean gia \u0111\u1ed3ng thu\u1eadn th\u1eddi \u0111i\u1ec3m 6 th\u00e1ng sau \u0111\u1ed9t qu\u1ef54. C\u00e1c thang \u0111i\u1ec3m \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 bao g\u1ed3m MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), ACE-R (Addenbrookes Cognitive Evaluation Revised)4. \u1ede Vi\u1ec7t Nam, ch\u00fang ta th\u01b0\u1eddng s\u1eed d\u1ee5ng thang \u0111i\u1ec3m MMSE v\u00e0 MoCA b\u1ea3n Vi\u1ec7t h\u00f3a. B\u1ea3ng \u0111\u00e1nh gi\u00e1 th\u1ea7n kinh Montreal (MoCA) nh\u1ea1y h\u01a1n MMSE trong vi\u1ec7c ph\u00e1t hi\u1ec7n SGNT nh\u1eb9 sau \u0111\u1ed9t qu\u1ef5, tuy nhi\u00ean \u0111\u00f2i h\u1ecfi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 khi\u1ebfm khuy\u1ebft th\u1ecb gi\u00e1c-kh\u00f4ng gian v\u00e0 ng\u00f4n ng\u1eef. Thang \u0111i\u1ec3m MoCA \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u00e1p d\u1ee5ng sau giai \u0111o\u1ea1n \u0111\u1ed9t qu\u1ef5 c\u1ea5p v\u00ec \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n trong giai \u0111o\u1ea1n c\u1ea5p, v\u00e0 d\u00f9ng \u0111i\u1ec3m c\u1eaft th\u1ea5p h\u01a1n (22 \u00b1 1 \u0111i\u1ec3m) so v\u1edbi khi \u0111\u00e1nh gi\u00e1 b\u1ec7nh Alzheimer (25 \u00b1 1 \u0111i\u1ec3m) v\u00ec \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u cao h\u01a1n (0,84 v\u00e0 0,78)4. Thang \u0111i\u1ec3m MMSE c\u00f3 \u0111\u1ed9 nh\u1ea1y 0,72 v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 0,76 v\u1edbi \u0111i\u1ec3m c\u1eaft quy \u01b0\u1edbc (26 \u00b1 1) c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u00e1p d\u1ee5ng \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c trong giai \u0111o\u1ea1n c\u1ea5p l\u1eabn sau giai \u0111o\u1ea1n c\u1ea5p, tuy nhi\u00ean c\u0169ng \u0111\u00f2i h\u1ecfi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 khi\u1ebfm khuy\u1ebft th\u1ecb gi\u00e1c-kh\u00f4ng gian v\u00e0 ng\u00f4n ng\u1eef. Trong giai \u0111o\u1ea1n d\u1ecbch Covid-19 v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p d\u00e3n c\u00e1ch l\u00e0m cho b\u1ec7nh nh\u00e2n kh\u00f3 ti\u1ebfp c\u1eadn ch\u0103m s\u00f3c y t\u1ebf tr\u1ef1c ti\u1ebfp th\u00ec vi\u1ec7c \u0111\u00e1nh gi\u00e1 t\u1eeb xa (remote assessment) ng\u00e0y c\u00e0ng tr\u1edf n\u00ean c\u1ea7n thi\u1ebft. H\u1ed9i \u0110\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u khuy\u1ebfn c\u00e1o m\u1ed9t s\u1ed1 thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c t\u1eeb xa tr\u00ean n\u1ec1n t\u1ea3ng \u0111i\u1ec7n tho\u1ea1i ho\u1eb7c cu\u1ed9c g\u1ecdi video khi kh\u00f4ng th\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n tr\u1ef1c ti\u1ebfp, g\u1ed3m: ph\u1ecfng v\u1ea5n t\u00ecnh tr\u1ea1ng nh\u1eadn th\u1ee9c qua \u0111i\u1ec7n tho\u1ea1i (TICS, Telephone Interview for Cognitive Status), thang \u0111\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c Montreal qua \u0111i\u1ec7n tho\u1ea1i (t-MoCA) v\u00e0 t-MoCA r\u00fat g\u1ecdn4, Trong \u0111\u00f3, thang t-MoCA \u0111\u00e1nh gi\u00e1 c\u00e1c l\u0129nh v\u1ef1c nh\u1eadn th\u1ee9c tr\u00ed nh\u1edb, ng\u00f4n ng\u1eef, \u0111\u1ecbnh h\u01b0\u1edbng, tr\u00ed nh\u1edb mu\u1ed9n v\u1edbi t\u1ed5ng \u0111i\u1ec3m 12 cho \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u01b0\u01a1ng \u0111\u1ed1i cao (0,98 v\u00e0 0,73) so v\u1edbi hai thang \u0111i\u1ec3m c\u00f2n l\u1ea1i4.<\/p>\n

6. TI\u00caN L\u01af\u1ee2NG<\/strong><\/h2>\n

SSTT sau \u0111\u1ed9t qu\u1ef5 c\u00f3 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 v\u1ec1 d\u00e2n s\u1ed1 h\u1ecdc (tu\u1ed5i cao, h\u1ecdc v\u1ea5n th\u1ea5p, gi\u1edbi n\u1eef), b\u1ec7nh n\u1ed9i khoa (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, rung nh\u0129), \u0111\u1eb7c \u0111i\u1ec3m v\u00e0 \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ed9t qu\u1ef5 (khi\u1ebfm khuy\u1ebft ng\u00f4n ng\u1eef, t\u1ed5n th\u01b0\u01a1ng b\u00e1n c\u1ea7u \u01b0u th\u1ebf, \u0111i\u1ec3m NIHSS cao), \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh h\u1ecdc (teo n\u00e3o, t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng, teo th\u00f9y th\u00e1i d\u01b0\u01a1ng trong). Do \u0111\u00f3, c\u00e1c c\u00f4ng c\u1ee5 ti\u00ean l\u01b0\u1ee3ng \u0111a bi\u1ebfn, \u0111\u1eb7c \u0111i\u1ec3m CT v\u00e0\/ho\u1eb7c MRI trong giai \u0111o\u1ea1n c\u1ea5p \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng nguy c\u01a1 suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5. M\u1ed9t s\u1ed1 c\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c c\u00f4ng c\u1ee5 ti\u00ean l\u01b0\u1ee3ng \u0111a bi\u1ebfn nh\u01b0 CHANGE, SIGNAL2 \u2026ph\u1ed1i h\u1ee3p c\u00e1c bi\u1ebfn s\u1ed1 nh\u01b0 \u0111\u1eb7c \u0111i\u1ec3m d\u00e2n s\u1ed1, \u0111\u1ed9 n\u1eb7ng c\u1ee7a \u0111\u1ed9t qu\u1ef5, th\u1ec3 \u0111\u1ed9t qu\u1ef5, \u0111i\u1ec3m th\u1ea7n kinh t\u00e2m th\u1ea7n v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m h\u00ecnh \u1ea3nh h\u1ecdc\u2026 kh\u00f4ng cho th\u1ea5y c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 \u00e1p d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 \u0111\u1eb7c \u0111i\u1ec3m CT g\u1ed3m teo n\u00e3o, t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng v\u00e0 nh\u1ed3i m\u00e1u y\u00ean l\u1eb7ng c\u00f3 nguy c\u01a1 nhi\u1ec5u cao, m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p \u0111\u1ebfn th\u1ea5p kh\u00f4ng gi\u00fap \u0111\u01b0a ra khuy\u1ebfn c\u00e1o ti\u00ean l\u01b0\u1ee3ng SGNT sau \u0111\u1ed9t qu\u1ef5 sau 1 n\u0103m4. C\u00f3 10 nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 \u0111\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn s\u1ed1 h\u00ecnh \u1ea3nh h\u1ecdc MRI g\u1ed3m t\u0103ng t\u00edn hi\u00eau ch\u1ea5t tr\u1eafng (\u0111\u00e1nh gi\u00e1 b\u1eb1ng thang \u0111i\u1ec3m Fazekas), teo n\u00e3o, th\u1ec3 t\u00edch t\u1ed5n th\u01b0\u01a1ng, \u0111i\u1ec3m b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u nh\u1ecf, c\u00e1c vi xu\u1ea5t huy\u1ebft, d\u00e3n kho\u1ea3ng quanh m\u1ea1ch v\u1edbi ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c 1 n\u0103m sau \u0111\u1ed9t qu\u1ef5. 8 nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng v\u1edbi m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng trung b\u00ecnh cho th\u1ea5y c\u00f3 li\u00ean quan \u0111\u1ed9c l\u1eadp gi\u1eefa m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng v\u1edbi SGNT mu\u1ed9n sau 1 n\u0103m sau \u0111\u1ed9t qu\u1ef5. C\u00e1c nghi\u00ean c\u1ee9u v\u1edbi c\u00e1c bi\u1ebfn kh\u00e1c c\u00f3 m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng r\u1ea5t th\u1ea5p \u0111\u1ebfn th\u1ea5p. H\u1ed9i \u0111\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u khuy\u1ebfn c\u00e1o s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng do m\u1ea1ch m\u00e1u tr\u00ean MRI giai \u0111o\u1ea1n c\u1ea5p c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng SGNT sau 1 n\u0103m sau \u0111\u1ed9t qu\u1ef5. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m MRI kh\u00e1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u th\u00eam.<\/p>\n

7. \u0110I\u1ec0U TR\u1eca<\/strong><\/h2>\n

\u0110i\u1ec1u tr\u1ecb SGNT sau \u0111\u1ed9t qu\u1ef5 bao g\u1ed3m c\u00e1c kh\u00ed c\u1ea1nh \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng suy gi\u1ea3m nh\u1eadn th\u1ee9c, \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng nh\u1eadn th\u1ee9c v\u00e0 m\u1ed9t s\u1ed1 thu\u1ed1c dinh d\u01b0\u1ee1ng th\u1ea7n kinh \u0111i\u1ec1u ch\u1ec9nh b\u1ec7nh sinh.<\/p>\n

7.1. \u0110i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng<\/strong><\/h3>\n

C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y h\u01b0\u1edbng \u0111\u1ebfn vi\u1ec7c ch\u1ee9ng minh c\u00e1c can thi\u1ec7p thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, luy\u1ec7n t\u1eadp th\u1ec3 l\u1ef1c, \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 th\u1ee9 ph\u00e1t v\u1edbi thu\u1ed1c h\u1ea1 \u00e1p, statin, thu\u1ed1c ch\u1ed1ng huy\u1ebft kh\u1ed1i, luy\u1ec7n t\u1eadp nh\u1eadn th\u1ee9c v\u00e0 g\u1eafn k\u1ebft x\u00e3 h\u1ed9i gi\u00fap d\u1ef1 ph\u00f2ng SGNT sau \u0111\u1ed9t qu\u1ef5.
\nV\u1edbi gi\u1ea3 thi\u1ebft r\u1eb1ng \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 th\u1ee9 ph\u00e1t b\u1eb1ng c\u00e1ch ki\u1ec3m so\u00e1t c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1ea1ch m\u00e1u l\u00e0m gi\u1ea3m nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t s\u1ebd l\u00e0m nguy c\u01a1 SGNT sau \u0111\u1ed9t qu\u1ef5, c\u00e1c nghi\u00ean c\u1ee9u The Austrian Polyintervention Study to Prevent Cognitive Decline after Ischemic Stroke (ASPIS), nghi\u00ean c\u1ee9u c\u1ee7a Ihle-Hansen v\u00e0 c\u1ed9ng s\u1ef1, Cheng v\u00e0 c\u1ed9ng s\u1ef1 \u00e1p d\u1ee5ng c\u00e1c can thi\u1ec7p \u0111a m\u00f4 th\u1ee9c (multidomain interventions) bao g\u1ed3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5, can thi\u1ec7p l\u1ed1i s\u1ed1ng b\u1eb1ng ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, lipid, \u0111\u01b0\u1eddng huy\u1ebft, ch\u1ebf \u0111\u1ed9 \u0103n l\u00e0nh m\u1ea1nh, luy\u1ec7n t\u1eadp th\u1ec3 l\u1ef1c, luy\u1ec7n t\u1eadp nh\u1eadn th\u1ee9c, t\u01b0 v\u1ea5n ki\u1ec3m so\u00e1t y\u1ebfu t\u1ed1 nguy c\u01a1, cai thu\u1ed1c l\u00e1\u2026 kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch \u00fd ngh\u0129a trong ph\u00f2ng ng\u1eeba SGNT. C\u00e1c nghi\u00ean c\u1ee9u The Life After Stroke Trial (LAST), nghi\u00ean c\u1ee9u the MoveIT trial \u00e1p d\u1ee5ng can thi\u1ec7p ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c c\u0169ng cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. Do \u0111\u00f3 c\u00e1c can thi\u1ec7p tr\u00ean kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u00e1p d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c nh\u1eb1m m\u1ee5c \u0111\u00edch d\u1ef1 ph\u00f2ng SGNT. Tuy nhi\u00ean c\u00e1c chuy\u00ean gia v\u1eabn khuy\u1ebfn c\u00e1o \u00e1p d\u1ee5ng c\u00e1c can thi\u1ec7p tr\u00ean nh\u1eb1m l\u1ee3i \u00edch tr\u00ean s\u1ee9c kh\u1ecfe th\u1ec3 ch\u1ea5t v\u00e0 tinh th\u1ea7n, ph\u00f2ng ng\u1eeba c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch4.
\nKh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng n\u00e0o \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a luy\u1ec7n t\u1eadp nh\u1eadn th\u1ee9c (cognitive training) v\u00e0 g\u1eafn k\u1ebft x\u00e3 h\u1ed9i tr\u00ean b\u1ec7nh nh\u00e2n sau \u0111\u1ed9t qu\u1ef5 nh\u1eb1m ph\u00f2ng ng\u1eeba SGNT. Tuy nhi\u00ean c\u00f3 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 k\u1ebft c\u1ee5c l\u00e0 m\u1ed9t s\u1ed1 l\u0129nh v\u1ef1c nh\u1eadn th\u1ee9c nh\u1ea5t \u0111\u1ecbnh (ng\u00f4n ng\u1eef, nh\u1eadn th\u1ee9c\u2026) tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ed9t qu\u1ef5 cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh. C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb kh\u00f4ng khuy\u1ebfn c\u00e1o \u00e1p d\u1ee5ng luy\u1ec7n t\u1eadp nh\u1eadn th\u1ee9c trong ph\u00f2ng ng\u1eeba SGNT v\u00e0 SSTT tr\u00ean b\u1ec7nh nh\u00e2n sau \u0111\u1ed9t qu\u1ef5. Tuy nhi\u00ean c\u00e1c chuy\u00ean gia \u0111\u1ed3ng thu\u1eadn xem x\u00e9t \u00e1p d\u1ee5ng luy\u1ec7n t\u1eadp nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a g\u00f3i ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c can thi\u1ec7p kh\u00e1c4.
\n\u0110\u1ed1i v\u1edbi \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u00e1p, c\u00e1c nghi\u00ean c\u1ee9u NICE (nimodipine), PRoFESS (telmisartan), PROGRESS (perindopril) so s\u00e1nh c\u00e1c thu\u1ed9c h\u1ea1 \u00e1p v\u1edbi gi\u1ea3 d\u01b0\u1ee3c kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 SSTT sau \u0111\u1ed9t qu\u1ef5 d\u00f9 c\u00f3 hi\u1ec7u qu\u1ea3 nh\u1eb9 ph\u00f2ng ng\u1eeba SGNT (\u0111\u00e1nh gi\u00e1 d\u1ef1a v\u00e0o gi\u1ea3m \u0111i\u1ec3m MMSE \u2265 3 \u0111i\u1ec3m). Do \u0111\u00f3 kh\u00f4ng th\u1ec3 khuy\u1ebfn c\u00e1o ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u00edch c\u1ef1c \u0111\u01a1n \u0111\u1ed9c (so v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng) nh\u1eb1m m\u1ee5c \u0111\u00edch ph\u00f2ng ng\u1eeba SSTT sau \u0111\u1ed9t qu\u1ef5. T\u01b0\u01a1ng t\u1ef1, nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng SPS3 cho th\u1ea5y tr\u00ean b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u l\u1ed5 khuy\u1ebft trong v\u00f2ng 6 th\u00e1ng, kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p (clopidogrel + aspirin) ng\u1eafn ng\u00e0y kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 SGNT nh\u1eb9 v\u00e0 SSTT so v\u1edbi aspirin m\u00e0 c\u00f2n l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u. Do \u0111\u00f3, H\u1ed9i \u0110\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi m\u1ee5c \u0111\u00edch n\u00e0y, \u0111\u1eb7c bi\u1ec7t tr\u00ean b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u l\u1ed5 khuy\u1ebft. 1 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng so s\u00e1nh pravastatin 10mg v\u1edbi gi\u1ea3 d\u01b0\u1ee3c kh\u00f4ng cho th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m nguy c\u01a1 SGNT sau \u0111\u1ed9t qu\u1ef5. Do \u0111\u00f3 statin c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u0111\u01a1n \u0111\u1ed9c nh\u1eb1m m\u1ee5c \u0111\u00edch n\u00e0y. C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u1ee1 m\u1eabu nh\u1ecf PODCAST v\u00e0 SERVED-Memory cho th\u1ea5y ki\u1ec3m so\u00e1t t\u00edch c\u1ef1c c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 an to\u00e0n nh\u01b0ng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 ph\u00f2ng ng\u1eeba SGNT sau \u0111\u1ed9t qu\u1ef5 do \u0111\u00f3 kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o nh\u1eb1m m\u1ee5c \u0111\u00edch n\u00e0y.<\/p>\n

7.2. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng suy gi\u1ea3m nh\u1eadn th\u1ee9c v\u00e0 h\u00e0nh vi t\u00e2m th\u1ea7n<\/strong><\/h3>\n

L\u1ee3i \u00edch c\u1ee7a thu\u1ed1c kh\u00e1ng men cholinesterase trong \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng nh\u1eadn th\u1ee9c v\u00e0 h\u00e0nh vi-t\u00e2m th\u1ea7n tr\u00ean b\u1ec7nh Alzheimer \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh v\u00e0 khuy\u1ebfn c\u00e1o. V\u1edbi gi\u1ea3 thi\u1ebft nh\u00f3m thu\u1ed1c n\u00e0y c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 tr\u00ean SGNT sau \u0111\u1ed9t qu\u1ef5, c\u00f3 8 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean b\u1ec7nh nh\u00e2n SSTT ho\u1eb7c SGNT m\u1ea1ch m\u00e1u bao g\u1ed3m b\u1ec7nh nh\u00e2n sau \u0111\u1ed9t qu\u1ef5 cho th\u1ea5y donepezil 10mg v\u00e0 galantamine 16 \u2013 24mg c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c (\u0111i\u1ec3m ADAS-Cog) v\u1edbi m\u1ee9c \u0111\u1ed9 b\u1eb1ng ch\u1ee9ng trung b\u00ecnh, rivastigmine 3 \u2013 12mg\/ng\u00e0y kh\u00f4ng ho\u1eb7c \u00edt c\u00f3 hi\u1ec7u qu\u1ea3 c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c v\u1edbi m\u1ee9c b\u1eb1ng ch\u1ee9ng th\u1ea5p. Tuy nhi\u00ean ph\u00e2n t\u00edch ri\u00eang nh\u00f3m b\u1ec7nh nh\u00e2n SGNT sau \u0111\u1ed9t qu\u1ef5 trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c. Trong 8 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean ch\u1ec9 c\u00f3 1 th\u1eed nghi\u1ec7m ch\u1ec9 tr\u00ean b\u1ec7nh nh\u00e2n SGNT sau \u0111\u1ed9t qu\u1ef5 kh\u00f4ng SSTT \u0111\u00e1nh gi\u00e1 rivastigmine 9mg\/ng\u00e0y cho th\u1ea5y khuynh h\u01b0\u1edbng c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng \u0111i\u1ec1u h\u00e0nh (\u0111i\u1ec3m Color Trail II) nh\u01b0ng kh\u00f4ng \u00fd ngh\u0129a th\u1ed1ng k\u00ea, kh\u00f4ng c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c chung, ho\u1ea1t \u0111\u1ed9ng s\u1ed1ng h\u00e0ng ng\u00e0y (ADL) v\u00e0 h\u00e0nh vi-t\u00e2m th\u1ea7n.
\nKh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u n\u00e0o \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a memantin ch\u1ec9 tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng SGNT sau \u0111\u1ed9t qu\u1ef5. Ph\u00e2n t\u00edch Cochran 3 nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n SSTT m\u00e1u cho th\u1ea5y hi\u1ec7u qu\u1ea3 khi\u00eam t\u1ed1n tr\u00ean nh\u1eadn th\u1ee9c v\u00e0 h\u00e0nh vi nh\u01b0ng t\u0103ng bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i.
\nDo \u0111\u00f3 c\u00e1c thu\u1ed1c kh\u00e1ng men cholinesterase v\u00e0 memantin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c, h\u00e0nh vi-t\u00e2m th\u1ea7n, ho\u1ea1t \u0111\u1ed9ng s\u1ed1ng h\u00e0ng ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n SGNT sau \u0111\u1ed9t qu\u1ef5 c\u0169ng nh\u01b0 gi\u1ea3m g\u00e1nh n\u1eb7ng ng\u01b0\u1eddi ch\u0103m s\u00f3c4. Tuy nhi\u00ean, c\u00e1c chuy\u00ean gia \u0111\u1ed3ng thu\u1eadn c\u00f3 th\u1ec3 xem x\u00e9t ch\u1ec9 \u0111\u1ecbnh sau khi c\u00e2n nh\u1eafc l\u1ee3i \u00edch khi\u00eam t\u1ed1n v\u00e0 nguy c\u01a1 bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i. L\u1ee3i \u00edch t\u1ed1i thi\u1ec3u tr\u00ean b\u1ec7nh nh\u00e2n SGNT m\u1ea1ch m\u00e1u \u0111\u01a1n thu\u1ea7n. C\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u1edf ng\u01b0\u1eddi cao tu\u1ed5i c\u00f3 SSTT h\u1ed7n h\u1ee3p ho\u1eb7c c\u00f3 b\u1ec7nh Alzheimer ho\u1eb7c sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy \u0111i k\u00e8m4.
\nActovegin v\u00e0 cerebrolysin l\u00e0 c\u00e1c thu\u1ed1c dinh d\u01b0\u1ee1ng th\u1ea7n kinh chi\u1ebft xu\u1ea5t t\u1eeb \u0111\u1ed9ng v\u1eadt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf nhi\u1ec1u qu\u1ed1c gia cho nhi\u1ec1u ch\u1ec9 \u0111\u1ecbnh kh\u00e1c nhau bao g\u1ed3m SSTT d\u00f9 ch\u01b0a \u0111\u01b0\u1ee3c ph\u00ea chu\u1ea9n c\u1ea5p qu\u1ed1c t\u1ebf. 1 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng tr\u00ean b\u1ec7nh nh\u00e2n SGNT sau \u0111\u1ed9t qu\u1ef5 cho th\u1ea5y actovegin c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c (\u0111i\u1ec3m ADAS-Cog) nh\u01b0ng kh\u00f4ng c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng, kh\u00f4ng c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c chung v\u00e0 t\u1ef7 l\u1ec7 SSTT. Ph\u00e2n t\u00edch g\u1ed9p 6 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng tr\u00ean 597 b\u1ec7nh nh\u00e2n SSTT m\u1ea1ch m\u00e1u nh\u1eb9-v\u1eeba, bao g\u1ed3m b\u1ec7nh nh\u00e2n SGNT sau \u0111\u1ed9t qu\u1ef5 cho th\u1ea5y cerebrolysin c\u1ea3i thi\u1ec7n nh\u1eadn th\u1ee9c (MMSE, ADAS-cog+), ch\u1ee9c n\u0103ng chung (CIBIC+, CGI) v\u1edbi nh\u00f3m ch\u1ee9ng, tuy nhi\u00ean s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y ch\u01b0a \u0111\u1ee7 l\u1edbn \u0111\u1ec3 c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng. T\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd kh\u00f4ng kh\u00e1c bi\u1ec7t so v\u1edbi nh\u00f3m ch\u1ee9ng. Do \u0111\u00f3 kh\u00f4ng \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch-nguy c\u01a1, H\u1ed9i \u0110\u1ed9t qu\u1ef5 ch\u00e2u \u00c2u (2021) kh\u00f4ng khuy\u1ebfn c\u00e1o actovegin v\u00e0 cerebrolysin rein tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng SGNT sau \u0111\u1ed9t qu\u1ef54. Tuy nhi\u00ean tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng SSTT m\u1ea1ch m\u00e1u nh\u1eb9 \u2013 trung b\u00ecnh, H\u1ed9i b\u1ec7nh Alzheimer v\u00e0 sa s\u00fat tr\u00ed tu\u1ec7 Vi\u1ec7t Nam khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cerebrolysis nh\u1eb1m c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c v\u00e0 ch\u1ee9c n\u0103ng t\u1ed5ng th\u1ec3 v\u1edbi b\u1eb1ng ch\u1ee9ng m\u1ee9c \u0111\u1ed9 I v\u00e0 II, b\u1eb1ng ch\u1ee9ng m\u1ee9c \u0111\u1ed9 B.<\/p>\n

8. K\u1ebeT LU\u1eacN<\/strong><\/h2>\n

Suy gi\u1ea3m nh\u1eadn th\u1ee9c th\u01b0\u1eddng g\u1eb7p sau \u0111\u1ed9t qu\u1ef5, l\u00e0 m\u1ed9t l\u0129nh v\u1ef1c m\u1edbi v\u1edbi kh\u00e1i ni\u1ec7m r\u1ed9ng bao g\u1ed3m suy gi\u1ea3m nh\u1eadn th\u1ee9c c\u00f3 hay kh\u00f4ng sa s\u00fat tr\u00ed tu\u1ec7, do c\u0103n nguy\u00ean m\u1ea1ch m\u00e1u hay tho\u00e1i h\u00f3a th\u1ea7n kinh nguy\u00ean ph\u00e1t hay h\u1ed7n h\u1ee3p.
\nCho t\u1edbi nay, r\u1ea5t \u00edt b\u1eb1ng ch\u1ee9ng tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n n\u00e0y c\u0169ng nh\u01b0 r\u1ea5t \u00edt ph\u00e2n t\u00edch d\u01b0\u1edbi nh\u00f3m t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng suy gi\u1ea3m nh\u1eadn th\u1ee9c m\u1ea1ch m\u00e1u kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 \u0111\u01b0a ra c\u00e1c khuy\u1ebfn c\u00e1o m\u1ea1nh. Th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o \u0111\u1ed3ng thu\u1eadn chuy\u00ean gia.
\nTrong ch\u1ea9n \u0111o\u00e1n, khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng c\u00e1c test nh\u1eadn th\u1ee9c tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 bi\u1ec3u hi\u1ec7n suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5.
\n\u0110\u1ec3 ph\u00f2ng ng\u1eeba, m\u1eb7c d\u00f9 l\u1ee3i \u00edch d\u1ef1 ph\u00f2ng suy gi\u1ea3m nh\u1eadn th\u1ee9c kh\u00f4ng r\u00f5 r\u00e0ng nh\u01b0ng thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 mang l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch v\u1ec1 s\u1ee9c kh\u1ecfe v\u00e0 d\u1ef1 ph\u00f2ng c\u00e1c bi\u1ebfn c\u1ed1 m\u1ea1ch m\u00e1u.
\n\u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb, xem x\u00e9t d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng men cholinesterase, memantin, dinh d\u01b0\u1ee1ng th\u1ea7n kinh, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i c\u00f3 suy gi\u1ea3m nh\u1eadn th\u1ee9c h\u1ed7n h\u1ee3p, c\u00f3 b\u1ec7nh Alzheimer ho\u1eb7c sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Lewy \u0111i k\u00e8m.<\/p>\n

T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/h2>\n

V\u0169 Anh Nh\u1ecb (2007). Sa s\u00fat tr\u00ed tu\u1ec7. S\u1ed5 tay l\u00e2m s\u00e0ng th\u1ea7n kinh sau \u0111\u1ea1i h\u1ecdc. Trang 41-57.
\nLeys D, et al. Poststroke Dementia. Cerebrovasc Dis 2006; 22:61\u201370.
\nMoorhouse P et al. Vascular cognitive impairment: current concepts and clinical developments. Lancet Neurol 2008;7:246\u2013255.
\nQuinn T.J et al. European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment. Eur J Neurol. 2021;28:3883\u20133920.
\nPendlebury ST, Rothwell PM; Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019 Mar;18(3):248-258.
\nNguy\u1ec5n Th\u1ecb Ph\u01b0\u01a1ng Nga v\u00e0 c\u1ed9ng s\u1ef1. T\u1ef7 l\u1ec7 v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a sa s\u00fat tr\u00ed tu\u1ec7 sau \u0111\u1ed9t qu\u1ef5 n\u00e3o. Y h\u1ecdc th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh. T\u1eadp 17, ph\u1ee5 b\u1ea3n s\u1ed1 3, n\u0103m 2013.
\nPendlebury ST. Dementia in patients hospitalized with stroke: rates, time course, and clinico-pathologic factors. Int J Stroke. 2012 Oct;7(7):570-81.
\nThal D.R et al. Vascular dementia: different forms of vessel disorders contribute to the development of dementia in the elderly brain. Exp Gerontol. 2012 November; 47(11): 816\u2013824.
\nSachdev P, et al. Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014; 28(3): 206\u2013218.
\nThiel A, et al. Amyloid Burden, Neuroinflammation, and Links to Cognitive Decline After Ischemic Stroke. Stroke. 2014;45:2825-2829.
\nPendlebury ST, et al. Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study. Stroke. 2010 Jun;41(6):1290-3.
\nDrozdowska BA, et al. Prognostic rules for predicting cognitive syndromes following stroke: A systematic review. European Stroke Journal. 2021 Mar;6(1):18-27.
\nMatz K, et al. Multidomain lifestyle interventions for the prevention of cognitive decline after ischemic stroke:randomized trial. Stroke. 2015;46(10):2874-2880.
\nIhle-Hansen H, et al. Multifactorial vascular risk factor intervention to prevent cognitive impairment after stroke and TIA: a 12-month randomized controlled trial. Int J Stroke. 2014;9(7):932-938.
\nCheng C, et al. Comprehensive rehabilitation training decreases cognitive impairment, anxiety, and depression in Poststroke patients: a randomized controlled study. J Stroke Cerebrovasc Dis. 2018; 27(10):2613-2622.
\nIhle-Hansen H, et al. A physical activity intervention to prevent cognitive decline after stroke: secondary results from the Life After Stroke study, an 18-month randomized controlled trial. J Rehabil Med 2019;51(9):646-651.
\nDeijle I, et al. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the moveit study. Eur Stroke J. 2018;3(1 Supplement 1):91.
\nDiener HC, et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the prevention regimen for effectively avoiding second strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008;7(10):875-884.
\nPROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-Lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033-1041.
\nPearce LA, et al. Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial. Lancet Neurol. 2014;13(12):1177-1185.
\nSPS3 investigators. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. NEJM. 2012;367:817-825.
\nHosomi N, et al. The Japan Statin Treatment Against Recurrent Stroke (J-STARS): a multicenter, randomized, open-label, parallel-group study. EBioMedicine. 2015;2(9):1071-1078.
\nBath PM, et al. Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot \u2018prevention of decline in cognition after stroke trial\u2019 (PODCAST) randomised controlled trial. PLoS ONE. 2017;12:e0164608.
\nDavison WJ, et al. Can cardiovascular risk management be improved by shared care with general practice to prevent cognitive decline following stroke\/TIA? A feasibility randomised controlled trial (SERVED memory). BMC Geriatr. 2020;20:353.
\nBattle CE, et al. Cholinesterase inhibitors for vascular dementia and other vascularcognitive impairments: a network meta-analysis.Cochrane Database Syst Rev. 2021;2021(2):CD013306.
\nNarasimhalu K, et al. A randomised controlled trial of Rivastigmine in patients with cognitive impairment no dementia because of cerebrovascular disease. Acta Neurol Scand.2010;121:217-224.
\nMcShane R, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019;3(3):CD003154
\nGuekht A, et al. A randomized controlled trial to assess the efficacy of actovegin in poststroke cognitive impairment. Stroke. 2017;48:1262-1270.
\nCui S, Chen N, Yang M, et al. Cerebrolysin for vascular dementia.Cochrane Database Syst Rev. 2019;11:CD008900.
\nH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb SSTT, 2018. H\u1ed9i b\u1ec7nh Alzheimer v\u00e0 RLTK nh\u1eadn th\u1ee9c, www.alzvietnam.org<\/p>\n","protected":false},"excerpt":{"rendered":"

Suy gi\u1ea3m nh\u1eadn th\u1ee9c th\u01b0\u1eddng g\u1eb7p sau \u0111\u1ed9t qu\u1ef5 v\u1edbi t\u1ef7 l\u1ec7 20% t\u1ea1i th\u1eddi \u0111i\u1ec3m 6 th\u00e1ng sau \u0111\u1ed9t qu\u1ef5. Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 l\u00e0 t\u1ea5t c\u1ea3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c x\u1ea3y ra sau \u0111\u1ed9t qu\u1ef5 b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n l\u00e0 g\u00ec, c\u00f3 th\u1ec3 do nhi\u1ec1u qu\u00e1 […]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nSuy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 l\u00e0 t\u1ea5t c\u1ea3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c x\u1ea3y ra sau \u0111\u1ed9t qu\u1ef5 b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Suy gi\u1ea3m nh\u1eadn th\u1ee9c sau \u0111\u1ed9t qu\u1ef5 - 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