Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke: The Sydney Stroke Study
Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke: The Sydney Stroke Study
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DOI：
10.1159/000091434
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发表时间：
2006-01-01
影响因子：
2.4
通讯作者：
Zagami, A. S.
中科院分区：
文献类型：
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作者：
Sachdev, P. S.;Brodaty, H.;Zagami, A. S.
背景：卒中后痴呆很常见，但其决定因素仍不完全清楚。方法：在悉尼卒中研究中，我们对169名年龄在50-85岁、卒中后3-6个月的患者和103名对照组进行了详细的神经心理学和医学-精神病学评估，两组中的大多数都接受了MRI脑扫描。中风患者被一致诊断为有血管性轻度认知障碍(VaMCI)或血管性痴呆(VaD)或无认知障碍。采用计划Logistic回归分析人口统计、功能、脑血管危险因素和神经影像参数作为痴呆的决定因素。结果：VaD的诊断率为21.3%，其中50~59岁1例，60~69岁24%，70~79岁23%。性别差异不大。VaMCI患病率为36.7%。VaD患者病前智能功能较低，受教育年限比对照组少0.9年。VaD组和VaMCI组在任何特定的脑血管危险因素上与无认知损害组没有差异，但总体而言，有损害的组具有更多的危险因素。在抑郁严重程度、同型半胱氨酸水平和神经成像参数(萎缩、梗死体积和梗死数)上，除了VaD和VaMCI组白质病变过多和梗死灶数量较多外，他们没有一致的差异。在一系列Logistic回归分析中，卒中体积和病前功能是卒中患者认知功能障碍的重要决定因素。结论：卒中后痴呆和MCI很常见，尤其是在老年人中。脑血管危险因素不是VAD的独立危险因素，但每搏量是痴呆的重要决定因素。病前功能是卒中后功能障碍的决定因素。版权所有(C)2006 S.Karger AG，巴塞尔。
Background: Dementia following stroke is common but its determinants are still incompletely understood. Methods: In the Sydney Stroke Study, we performed detailed neuropsychological and medical-psychiatric assessments on 169 patients aged 50 - 85 years, 3 - 6 months after a stroke, and 103 controls with a majority of both groups undergoing MRI brain scans. Stroke subjects were diagnosed as having vascular mild cognitive impairment (VaMCI) or vascular dementia (VaD) or no cognitive impairment by consensus. Demographic, functional, cerebrovascular risk factors and neuroimaging parameters were examined as determinants of dementia using planned logistic regression. Results: 21.3% of subjects were diagnosed with VaD, with one case in those aged 50 - 59 years, 24% in those aged 60 - 69 years and 23% in those 70 - 79 years. There was no difference by sex. The prevalence of VaMCI was 36.7%. VaD subjects had lower premorbid intellectual functioning and had 0.9 years less education than controls. The VaD and VaMCI groups did not differ from the no cognitive impairment group on any specific cerebrovascular risk factor, however overall those with impairment had a greater number of risk factors. They did not differ consistently on depression severity, homocysteine levels and neuroimaging parameters ( atrophy, infarct volume and number of infarcts) except for an excess of white matter lesions on MRI and greater number of infarcts in the VaD and VaMCI groups. On a series of logistic regression analyses, stroke volume and premorbid function were significant determinants of cognitive impairment in stroke patients. Conclusion: Post-stroke dementia and MCI are common, especially in older individuals. Cerebrovascular risk factors are not independent risk factors for VaD, but stroke volume is a significant determinant of dementia. Premorbid functioning is a determinant of post-stroke impairment. Copyright (C) 2006 S. Karger AG, Basel.