Risk Factors Associated With Early vs Delayed Dementia After Intracerebral Hemorrhage.
Risk Factors Associated With Early vs Delayed Dementia After Intracerebral Hemorrhage.
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DOI：
10.1001/jamaneurol.2016.0955
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发表时间：
2016-08-01
期刊：
影响因子：
29
通讯作者：
Viswanathan A
中科院分区：
文献类型：
--
作者：
Biffi A;Bailey D;Anderson CD;Ayres AM;Gurol EM;Greenberg SM;Rosand J;Viswanathan A
脑出血 (ICH) 幸存者在 ICH 后早期和长期出现认知障碍的几率似乎很高。识别和比较 ICH 后早期和迟发性痴呆的危险因素。 2006 年 1 月至 2013 年 12 月期间招募 ICH 幸存者的纵向研究。三级护理学术机构。 1141 名患有原发性 ICH、年龄≥ 18 岁且没有 ICH 前期痴呆的个体被考虑纳入研究。其中，24 人拒绝同意，379 人不符合资格。因此，共有 738 名 ICH 幸存者被纳入 ICH 后早期痴呆 (EPID) 分析。在考虑了 6 个月时的痴呆事件和死亡率后，435 名参与者被纳入了迟发性脑出血后痴呆 (DPID) 的分析中。临床病史和人口统计信息、随访期间的药物暴露情况。所有受试者在 ICH 时均接受 CT 扫描，以确定血肿位置和大小，以及 CT 定义的白质病 (CT-WMD) 的严重程度。使用改良电话访谈认知状态测试来捕获认知表现。结果包括： 1) EPID，在 ICH 后 6 个月内诊断； 2) DPID，在 ICH 后 6 个月以上诊断。在 738 名 ICH 幸存者中，140 名（19%）在 6 个月内患上痴呆症。对 6 个月时总共 435 例无痴呆的 ICH 进行了纵向随访（中位随访 47.4 个月，四分位数范围 [IQR] 43.4 - 52.1），估计痴呆年发病率为 5.8%（95%CI 5.1-7.0%）。较大的血肿大小（每增加 10cc 风险比 [HR] 1.47，95% 置信区间 [95%CI] 1.09-1.97）和脑叶 ICH 位置（HR 2.04，95% CI 1.06 - 3.91）与 EPID 特别相关，但与 DPID 无关（两者的异质性 p<0.05）。教育水平（HR 0.60，95%CI 0.40-0.89）、突发情绪症状（HR 1.29，95%CI 1.02-1.63）和 CT-WMD（HR 1.70，95%CI 1.07-2.71）与 DPID 特别相关，但与 EPID 无关（异质性 p<0.05）。脑出血后早期发生的痴呆与血肿大小和位置密切相关。迟发性痴呆在脑出血幸存者中很常见，并且与急性脑出血特征没有显着相关性。这些发现表明，脑出血幸存者的早期认知能力下降与延迟认知能力下降存在异质性生物学机制。
Intracerebral hemorrhage (ICH) survivors appear to develop cognitive impairment at high rates, both early after ICH and long-term. to identify and compare risk factors for early and delayed dementia after ICH. longitudinal study enrolling ICH survivors from January 2006 to December 2013. tertiary care academic institution. 1141 individuals with primary ICH, age ≥ 18 years and without pre-ICH dementia were considered for study enrollment. Of these, 24 refused consent and 379 were otherwise ineligible. A total of 738 ICH survivors were therefore included in Early Post-ICH Dementia (EPID) analyses. After accounting for incident dementia and mortality at 6 months, 435 participants were included in analyses of Delayed Post-ICH Dementia (DPID). clinical history and demographic information, medications exposure during follow-up. All subjects underwent CT scanning at time of ICH to determine hematoma location and size, as well as severity of CT-defined White Matter Disease (CT-WMD). Cognitive performance was captured using the Modified Telephone Interview for Cognitive Status test. Outcomes included: 1) EPID, diagnosed within 6 months after ICH; 2) DPID, diagnosed beyond 6 months after ICH. Among 738 ICH survivors, 140 (19%) developed dementia within 6 months. A total of 435 ICH without dementia at 6 months were followed longitudinally (median follow-up 47.4 months, Inter-Quartile Range [IQR] 43.4 - 52.1), with estimated yearly dementia incidence of 5.8% (95%CI 5.1-7.0%). Larger hematoma size (Hazard Ratio [HR] 1.47 per 10cc increase, 95% Confidence Interval [95%CI] 1.09-1.97) and lobar ICH location (HR 2.04, 95% CI 1.06 - 3.91) were specifically associated with EPID, but not with DPID (heterogeneity p<0.05 for both). Educational level (HR 0.60, 95%CI 0.40-0.89), incident mood symptoms (HR 1.29, 95%CI 1.02-1.63), and CT-WMD (HR 1.70, 95%CI 1.07-2.71) were specifically associated with DPID, but not EPID (heterogeneity p<0.05 for all). Early incident dementia after ICH is strongly associated with hematoma size and location. Delayed incident dementia is frequent among ICH survivors, and not prominently associated with acute ICH characteristics. These findings suggest the existence of heterogeneous biological mechanisms accounting for early vs. delayed cognitive decline among ICH survivors.