The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients
The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients
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DOI：
10.1161/strokeaha.110.594671
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发表时间：
2011-04-01
期刊：
影响因子：
8.3
通讯作者：
Chen, Christopher P.
中科院分区：
文献类型：
--
作者：
Narasimhalu, Kaavya;Ang, Sandy;Chen, Christopher P.
背景和目的：有证据表明，脑卒中后痴呆、认知障碍无痴呆（CIND）和轻度认知障碍预示着痴呆、死亡和住院等不良结局。然而，很少有研究在卒中后队列中检测CIND、CIND严重程度和结构域损伤的预后价值。方法：一组缺血性卒中患者在卒中后3个月进行基线认知评估，每年随访5年，观察依赖性、血管事件和死亡的结局。采用单因素和多因素Cox比例回归来确定CIND、CIND严重程度和结构域损伤预测依赖性、血管结局和死亡的能力。结果：419例无痴呆患者（平均年龄60±11岁，32%为女性）平均随访3.2年。年龄较大、糖尿病、更严重的中风、cind轻度和cind中度是依赖性的独立预测因素。没有血管事件复发的独立预测因子。年龄较大、糖尿病和中度糖尿病是独立预测死亡的因素。在个体认知领域的分析中，视觉运动速度的损伤是依赖性的独立预测指标。结论：在脑卒中后患者中，CIND可预测患者的依赖和死亡，而CIND严重程度可区分患者的生存率。视觉运动速度障碍独立预测依赖性。
Background and Purpose-There is some evidence that poststroke dementia, cognitive impairment no dementia (CIND), and mild cognitive impairment predict for poor outcomes such as dementia, death, and institutionalization. However, few studies have examined the prognostic value of CIND, CIND severity, and domain impairments in a poststroke cohort.Methods-A cohort of ischemic stroke patients with baseline cognitive assessments 3 months poststroke were followed up annually for outcomes of dependency, vascular events, and death for up to 5 years. Univariate and multivariate Cox proportional regression was performed to determine the ability CIND, CIND severity, and domain impairments to predict dependency, vascular outcomes, and death.Results-Four-hundred nineteen patients without dementia (mean age 60 +/- 11 years, 32% female) were followed for a mean of 3.2 years. Older age, diabetes, more severe strokes, CIND-mild, and CIND-moderate were independently predictive of dependency. There were no independent predictors of recurrent vascular events. Older age, diabetes, and CIND-moderate were independently predictive of death. In analyses of individual cognitive domains, impairments in visuomotor speed were independently predictive of dependency.Conclusions-In poststroke patients, CIND predicts dependency and death, while CIND severity discriminates patients with poor survival. Impairments in visuomotor speed independently predict dependency.