Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016.
Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016.
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DOI：
10.1161/strokeaha.120.031063
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发表时间：
2021-05
期刊：
影响因子：
8.3
通讯作者：
Glymour, M. Maria
中科院分区：
文献类型：
--
作者：
Eng, Chloe W.;Mayeda, Elizabeth R.;Gilsanz, Paola;Whitmer, Rachel A.;Kim, Anthony S.;Glymour, M. Maria
弗雷明翰心脏研究的结果表明，近几十年来痴呆症发病率的下降部分是由于中风发病率和死亡率的下降；然而，痴呆症发病率下降的趋势是否延伸到中风事件的幸存者仍不清楚。我们在一个具有全国代表性的队列中调查了与突发中风相关的记忆变化的时间趋势的证据。健康和退休研究(HRS)中50岁以上的成年人被跟踪调查了连续三个六年的时期(时期1：1998-2004，n=16,781；时期2：2004-2010，n=15,345；时期3：2010-2016；n=15,949)。如果参与者在纪元开始时没有中风，那么他们就被包括在纪元中。考虑到卒中前、卒中时和卒中后多年的记忆变化，使用人口统计学调整的线性回归模型比较了无卒中参与者、卒中后存活的参与者和卒中后死亡的参与者综合z标准化记忆得分的年变化率。卒中粗发病率从第一个时期的每千人年8.5例下降到第三个时期的每千人年6.8例。不同时期中风发作前后的记忆变化率是相似的。卒中后即刻记忆力减退从第1代的−0.37分(95%CI：−0.44，−0.29)下降到第2代的−0.26(95%CI：−0.33，−0.18)和第3代的−0.25(95%CI：−0.33，−0.17)点(线性趋势p值=0.02)。近年来与中风相关的痴呆症的减少可能部分归因于中风发作后立即出现的较小的记忆力下降。研究结果表明，中风发病率的降低和中风护理的改善也可能减少痴呆症的人口负担。需要进一步研究时间趋势是否可归因于卒中护理的改善。
Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort. Adults age 50+ in the Health and Retirement Study (HRS) were followed across three successive six-year epochs (Epoch 1: 1998–2004, n=16,781; Epoch 2: 2004–2010, n=15,345; Epoch 3: 2010–2016; n=15,949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change prior to stroke, at the time of stroke, and for years following stroke. Crude stroke incidence rates decreased from 8.5 per 1,000 person-years in Epoch 1 to 6.8 per 1,000 person-years in Epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from −0.37 points (95% CI: −0.44, −0.29) in Epoch 1 to −0.26 (95% CI: −0.33, −0.18) points in Epoch 2 and −0.25 (95% CI: −0.33, −0.17) points in Epoch 3 (p-value for linear trend = 0.02). Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.