Adverse Influence of Pre-Stroke Dementia on Short-Term Functional Outcomes in Patients with Acute Ischemic Stroke: The Fukuoka Stroke Registry
Adverse Influence of Pre-Stroke Dementia on Short-Term Functional Outcomes in Patients with Acute Ischemic Stroke: The Fukuoka Stroke Registry
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DOI：
10.1159/000453625
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Ago, Tetsuro
中科院分区：
文献类型：
--
作者：
Wakisaka, Yoshinobu;Matsuo, Ryu;Ago, Tetsuro
背景：痴呆和脑卒中是老年人致残的主要原因。然而，中风前痴呆与中风后功能预后之间的关系仍未得到解决。我们的目的是确定急性缺血性脑卒中患者的这种关联。方法：从2007年6月至2015年5月在福冈卒中登记处登记的患者中，选取4237例发病后24小时内功能独立的缺血性卒中患者作为研究对象。中风前痴呆被定义为在指数中风之前出现的任何类型的痴呆。主要和次要研究结果分别为卒中发作后3个月的功能预后差（改良Rankin量表3-6）和神经功能恶化（>=住院期间美国国立卫生研究院卒中量表评分增加2分）。为控制卒中前痴呆的混杂变量，采用倾向评分（PS）匹配队列研究，选取318对卒中前痴呆患者和非卒中前痴呆患者，按1:1匹配。采用多变量logistic回归模型和条件logistic回归分析量化脑卒中前痴呆与研究结果之间的关联。结果：在所有4237名参与者中，347名（8.2%）患有卒中前痴呆。脑卒中前痴呆患者出现神经功能恶化和功能不良的频率明显高于无脑卒中前痴呆患者（神经功能恶化，16.1比7.1%,p < 0.01；功能不良，63.7比27.1%,p < 0.01）。多变量分析显示，卒中前痴呆与神经功能恶化（OR 1.67; 95% CI 1.14-2.41; p < 0.01）和功能预后不良（OR 2.91; 95% CI 2.17-3.91; p < 0.01）显著相关。在ps匹配队列研究中，卒中前痴呆和神经功能恶化之间（OR 2.60; 95% CI 1.17-5.78; p < 0.01）以及痴呆和功能不良结局之间（OR 3.62; 95% CI 1.89-6.95; p < 0.01）也观察到相同的趋势。结论：脑卒中前痴呆与脑卒中发病后3个月功能预后不良以及急性缺血性脑卒中患者住院期间神经功能恶化的高风险显著相关。(C) 2016 S. Karger AG，巴塞尔
Background: Dementia and stroke are major causes of disability in the elderly. However, the association between prestroke dementia and functional outcome after stoke remains unresolved. We aimed to determine this association in patients with acute ischemic stroke. Methods: Among patients registered in the Fukuoka Stroke Registry from June 2007 to May 2015, 4,237 patients with ischemic stroke within 24 h of onset, who were functionally independent before the onset, were enrolled in this study. Pre-stroke dementia was defined as any type of dementia that was present prior to the index stroke. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale 3-6) at 3 months after the stroke onset and neurological deterioration (>= 2-point increases on the National Institutes of Health Stroke Scale score during hospitalization), respectively. For propensity score (PS)-matched cohort study to control confounding variables for pre-stroke dementia, 318 pairs of patients with and without pre-stroke dementia were also selected on the basis of 1: 1 matching. Multivariable logistic regression models and conditional logistic regression analysis were used to quantify associations between pre-stroke dementia and study outcomes. Results: Of all 4,237 participants, 347 (8.2%) had pre-stroke dementia. The frequencies of neurological deterioration and poor functional outcome were significantly higher in patients with pre-stroke dementia than in those without pre-stroke dementia (neurological deterioration, 16.1 vs. 7.1%, p < 0.01; poor functional outcome, 63.7 vs. 27.1%, p < 0.01). Multivariable analysis showed that pre-stroke dementia was significantly associated with neurological deterioration (OR 1.67; 95% CI 1.14-2.41; p < 0.01) and poor functional outcome (OR 2.91; 95% CI 2.17-3.91; p < 0.01). In the PS-matched cohort study, the same trends were observed between the pre-stroke dementia and neurological deterioration (OR 2.60; 95% CI 1.17-5.78; p < 0.01) and between the dementia and poor functional outcome (OR 3.62; 95% CI 1.89-6.95; p < 0.01). Conclusions: Pre-stroke dementia was significantly associated with higher risks for poor functional outcome at 3 months after stroke onset as well as for neurological deterioration during hospitalization in patients with acute ischemic stroke. (C) 2016 S. Karger AG, Basel