Cognitive impairment in lacunar strokes: the SPS3 trial.
Cognitive impairment in lacunar strokes: the SPS3 trial.
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DOI：
10.1002/ana.23733
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发表时间：
2012-09
影响因子：
11.2
通讯作者：
Benavente, Oscar R.
中科院分区：
文献类型：
--
作者：
Jacova, Claudia;Pearce, Lesly A.;Costello, Raymond;McClure, Leslie A.;Holliday, Stephen L.;Hart, Robert G.;Benavente, Oscar R.
腔隙性中风是认知障碍和血管性痴呆的主要原因。然而，缺乏对认知障碍的充分描述。本研究的目的是估计腔隙性卒中患者神经心理损伤的患病率并描述其特征。 SPS3 试验 (NCT: 00059306) 中的所有英语参与者都在基线时接受了神经心理学测试。使用已发布的标准将原始分数转换为 z 分数。记忆和/或非记忆领域有损伤（z≤-1.5）的人被归类为轻度认知损伤（MCI）。在 1636 名参与者中，所有测试的平均 z 分数均低于零，其中情景记忆（平均值范围为 -0.65 至 -0.92）、言语流畅性（平均值为 -0.89）和运动敏捷性（平均值为 -2.5）测试中的缺陷最大。 47% 的人被归类为患有 MCI：36% 遗忘，37% 遗忘多域，28% 不遗忘。在Rankin评分为0-1且Barthel评分=100的患者中，41%患有MCI。年龄较小[比值比 (OR) 每 10 年增加 = 0.87]、男性 (OR 1.3)、教育程度较低（与 0-4 年教育相比，OR 0.13-0.66）、中风后残疾 (OR 1.4) 和日常生活活动受损 (OR 1.8) 与 MCI 独立相关。在这个规模大、特征明确的腔隙性中风患者队列中，近一半患者存在轻度认知障碍，其中许多人身体残疾极小或没有。腔隙性中风患者的认知功能障碍在临床实践中通常被忽视，但可能与运动和感觉后遗症一样重要。
Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. All English-speaking participants in the SPS3 trial (NCT: 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z-scores using published norms. Those with impairment (z≤-1.5) in memory and/or non-memory domains were classified as having Mild Cognitive Impairment (MCI). Among the 1636 participants, average z scores on all tests were below zero with the largest deficits seen on tests of episodic memory (range of means -0.65 to -0.92), verbal fluency (mean -0.89), and motor dexterity (mean -2.5). Forty-seven percent were classified as having MCI: 36% amnestic, 37% amnestic multidomain, 28% non-amnestic. Of those with Rankin score 0-1 and Barthel score=100, 41% had MCI. Younger age [odds ratio (OR) per 10-yr increase=0.87], male sex (OR 1.3), less education (OR 0.13-0.66 compared to 0-4 yrs education), post-stroke disability (OR 1.4), and impaired activities of daily living (OR 1.8) were independently associated with MCI. In this large, well characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.
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