Evolution of cognitive impairment after stroke and risk factors for delayed progression
Evolution of cognitive impairment after stroke and risk factors for delayed progression
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DOI：
10.1161/01.str.0000189626.71033.35
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发表时间：
2005-12-01
期刊：
影响因子：
8.3
通讯作者：
Vivancos, J
中科院分区：
文献类型：
--
作者：
del Ser, T;Barba, R;Vivancos, J
背景和目的 - 大约 30% 的中风患者出现认知能力下降。急性风险因素已经确定，但长期风险尚未在大样本中进行检查。本研究的目的是确定与中风后认知障碍进展相关的因素。 方法 - 对先前没有痴呆的连续中风患者 (193) 在中风后 3 个月进行广泛的神经心理学电池评估，并根据《精神疾病诊断与统计手册》第四版标准和临床痴呆评级进行诊断：正常 (139)、无痴呆的认知能力下降 (18) 或痴呆 (18 名轻度、10 名中度和 8 名)严重）。经过 24 个月的随访后，根据临床痴呆评分的变化，将他们分为稳定、进展或改善。通过对所有临床、神经影像和补充数据进行逻辑回归分析，确定了认知能力下降进展的决定因素。 结果 - 大多数病例 (151；78.2%) 24 个月时的认知状态稳定，27 例（14%；6 例痴呆，21 例非痴呆）认知状态下降，15 例（7.8%；7 例痴呆，8 例非痴呆）有所改善。 7 名非痴呆患者在 24 个月时出现痴呆，5 名痴呆患者变为非痴呆。年龄（比值比 [OR]，1.05；95% CI，1.01 至 1.1）、卒中前智力下降（OR，1.14；95% CI，1.02 至 1.27）、处方药物数量（OR，1.34；95% CI，1.05 至 1.72）、入院时舒张压（OR，0.96；95% CI，1.02 至 1.27）。 95% CI，0.93 至 0.99）和入院期间低血压发作（OR，7.61；95% CI，1.11 至 52.1）与认知恶化显着相关。结论 - 中风后 2 年内认知相当稳定。痴呆患者中认知障碍的进展和改善都很常见。年龄、既往认知能力下降、多次用药和入院期间低血压是病情进展的危险因素。
Background and Purpose - Cognitive decline occurs in approximate to 30% of stroke patients. Acute risk factors have been identified, but long-term risk has not been examined in large samples. The purpose of this research was to determine factors associated with the progression of cognitive impairment after stroke.Methods - Consecutive stroke patients (193) without previous dementia were assessed 3 months after stroke with an extensive neuropsychological battery and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria and the Clinical Dementia Rating as normal (139), cognitive decline without dementia (18), or dementia (18 mild, 10 moderate, and 8 severe). After a 24-month follow-up, they were classified as stable, progressing, or improving, according to change in Clinical Dementia Rating score. The determinants of progression of cognitive decline were ascertained by logistic regression analysis of all clinical, neuroimaging, and complementary data.Results - Cognitive status at 24 months was stable in most cases (151; 78.2%), decline progressed in 27 (14%; 6 demented and 21 nondemented), and improved in 15 (7.8%; 7 demented and 8 nondemented). Seven nondemented patients became demented at 24 months, and 5 demented became nondemented. The age (odds ratio [OR], 1.05; 95% CI, 1.01 to 1.1), mental decline before stroke (OR, 1.14; 95% CI, 1.02 to 1.27), number of prescribed drugs (OR, 1.34; 95% CI, 1.05 to 1.72), diastolic blood pressure on admission (OR, 0.96; 95% CI, 0.93 to 0.99), and episodes of hypotension during admission (OR, 7.61; 95% CI, 1.11 to 52.1) were significantly associated with cognitive deterioration.Conclusions - Cognition is rather stable for 2 years after stroke. Both progression and improvement of cognitive impairment are frequent in demented patients. Age, previous cognitive decline, polypharmacy, and hypotension during admission are risk factors for progression.