Trajectory of Cognitive Decline After Incident Stroke.
Trajectory of Cognitive Decline After Incident Stroke.
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DOI：
10.1001/jama.2015.6968
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发表时间：
2015-07-07
期刊：
影响因子：
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通讯作者：
Wadley VG
中科院分区：
文献类型：
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作者：
Levine DA;Galecki AT;Langa KM;Unverzagt FW;Kabeto MU;Giordani B;Wadley VG
认知能力下降是中风幸存者残疾的主要原因。中风后幸存者认知变化的程度尚不确定。测量中风幸存者认知功能的变化，控制中风前的认知轨迹。前瞻性研究对居住在美国大陆的 23,572 名年龄≥45 岁且没有基线认知障碍的中风地理和种族差异原因 (REGARDS) 队列参与者进行了研究，2003-2007 年入组并随访至 2013 年 3 月 31 日。中位随访时间为 6.1 年（第 25-75 个百分位数：5.0-7.1 年）， 515 名参与者在专家裁定的中风事件中幸存，23,057 名参与者仍然没有中风。与时间相关的中风事件。主要结果是整体认知的变化（六项筛选，SIS；范围 0-6）。次要结果是新学习的变化（建立阿尔茨海默氏病单词表学习登记协会；范围 0-30）、言语记忆（单词表延迟回忆；范围 0-10）、执行功能（动物流畅性测试；范围 ≥0）以及认知障碍（SIS<5/受损与≥5/未受损）。对于所有测试，分数越高表示性能越好。中风与整体认知（0.10分；95% CI，0.04-0.17）、新学习（1.80分；95% CI，0.73-2.86）和言语记忆（0.60分；95% CI，0.13-1.07）的急剧下降相关。与非中风患者相比，中风患者的整体认知能力（每年快 0.06 分；95% CI，0.03-0.08）和执行功能（每年快 0.63 分；95% CI，0.12-1.15）下降更快，但与中风前斜率相比，新学习和言语记忆却没有下降。在幸存者中，卒中后急性认知障碍的风险差异无统计学意义（比值比，1.32；95% CI，0.95-1.83；P=0.097）；然而，与卒中前相比，卒中后发生认知障碍的发生率明显更快（比值比，每年 1.23；95% CI，1.10-1.38；P<0.001）。对于一名 70 岁的黑人女性，第 3 年的中风与更大的认知障碍事件相关：第 3 年的绝对差异 (95% CI) 为 4.0% (−1.2%–9.2%)，第 6 年为 12.4% (7.7%–17.1%)。中风事件与认知能力急剧下降有关，并且在 6 年内加速和持续认知能力下降。
Cognitive decline is a major cause of disability in stroke survivors. The magnitude of survivors’ cognitive changes after stroke is uncertain. To measure changes in cognitive function among survivors of incident stroke, controlling for their prestroke cognitive trajectories. Prospective study of 23,572 participants aged ≥45 years without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, residing in the continental United States, enrolled 2003–2007 and followed through March 31, 2013. Over a median follow-up of 6.1 years (25th–75th percentile: 5.0–7.1 years), 515 participants survived expert-adjudicated incident stroke and 23,057 remained stroke-free. Time-dependent incident stroke. The primary outcome was change in global cognition (Six-Item Screener, SIS; range 0–6). Secondary outcomes were change in new learning (Consortium to Establish a Registry for Alzheimer’s Disease Word List Learning; range 0–30), verbal memory (Word List Delayed Recall; range 0–10), and executive function (Animal Fluency Test; range ≥0), and cognitive impairment (SIS<5/impaired vs. ≥5/unimpaired). For all tests, higher scores indicate better performance. Stroke was associated with acute decline in global cognition (0.10 points; 95% CI, 0.04–0.17), new learning (1.80 points; 95% CI, 0.73–2.86), and verbal memory (0.60 points; 95% CI, 0.13–1.07). Participants with stroke, compared to those without stroke, demonstrated faster declines in global cognition (0.06 points per year faster; 95% CI, 0.03–0.08) and executive function (0.63 points per year faster; 95% CI, 0.12–1.15), but not in new learning and verbal memory, compared to prestroke slopes. Among survivors, the difference in risk of cognitive impairment acutely after stroke was not statistically significant (odds ratio, 1.32; 95% CI, 0.95–1.83; P=0.097); however, there was a significantly faster poststroke rate of incident cognitive impairment compared to the prestroke rate (odds ratio, 1.23 per year; 95% CI, 1.10–1.38; P<0.001). For a 70 year-old black woman, stroke at year 3 was associated with greater incident cognitive impairment: absolute difference (95% CI) of 4.0% (−1.2%–9.2%) at year 3 and 12.4% (7.7%–17.1% at year 6). Incident stroke was associated with an acute decline in cognition and also accelerated and persistent cognitive decline over 6 years.