Effect of a clinical stroke on the risk of dementia in a prospective cohort
Effect of a clinical stroke on the risk of dementia in a prospective cohort
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DOI：
10.1212/01.wnl.0000240285.89067.3f
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发表时间：
2006-10-24
期刊：
影响因子：
9.9
通讯作者：
O'Brien, R.
中科院分区：
文献类型：
--
作者：
Gamaldo, A.;Moghekar, A.;O'Brien, R.
目的：在前瞻性随访的老年受试者队列中，研究临床明显卒中后痴呆的风险和决定因素。研究方法：我们使用来自巴尔的摩老龄化纵向研究的335名受试者的前瞻性数据，检查了临床可检测到的中风对痴呆风险的影响，所有受试者在进入研究时认知和神经功能正常（进入研究时的平均年龄为75.1 ± 4.2岁）。结果如下：临床上明显的卒中在我们的队列中很常见（90岁时的累积风险为15.4%; 95%CI：10 - 22%），与未发生卒中的受试者相比，痴呆的风险增加（比值比[OR] 5.55; 95%CI：2.76 - 11.4）。大多数中风后痴呆的患者在中风前有轻度认知障碍的证据（19例中的14例）。此外，临床症状性卒中是轻度认知障碍转化为痴呆的主要风险因素（OR 12.4; 95%CI：1.5 - 99）。当中风前没有认知障碍时，随后痴呆的风险不会增加。病理资料表明，血管和阿尔茨海默病的病理导致中风前的损害。结论：脑卒中后痴呆可能是由脑卒中前存在的认知障碍决定的。
Objective: To examine the risk and determinants of dementia following a clinically overt stroke in a prospectively followed cohort of elderly subjects. Methods: We examined the effect of a clinically detectable stroke on the risk of dementia using prospective data from 335 subjects in the Baltimore Longitudinal Study of Aging, all of whom were cognitively and neurologically normal at entry into the study (mean age at entry 75.1 +/- 4.2 years). Results: Clinically overt strokes are common in our cohort (cumulative risk by age 90, 15.4%; 95% CI: 10 to 22%) and confer an increased risk of dementia compared to subjects without stroke (odds ratio [OR] 5.55; 95% CI: 2.76 to 11.4). The majority of patients who became demented after a stroke had evidence of mild cognitive impairment preceding the stroke (14 of 19). Moreover, a clinically symptomatic stroke was a major risk factor for the conversion of mild cognitive impairment to dementia (OR 12.4; 95% CI: 1.5 to 99). When cognitive impairment did not precede the stroke, there was no increase in the risk of subsequent dementia. Pathologic data indicate that both vascular and Alzheimer pathology leads to the prestroke impairment. Conclusion: Dementia after stroke may be determined by cognitive impairments that exist prior to the stroke.