Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke The KOSCO Study
Effect of Cognitive Reserve on Risk of Cognitive Impairment and Recovery After Stroke The KOSCO Study
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认知储备对认知障碍风险和中风后恢复的影响 KOSCO 研究
DOI：
10.1161/strokeaha.119.026829
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发表时间：
2020-01-01
期刊：
影响因子：
8.3
通讯作者：
Kim, Yun-Hee
中科院分区：
文献类型：
--
作者：
Shin, Minyoung;Sohn, Min Kyun;Kim, Yun-Hee
背景和目的-引入认知储备（CR）理论来解释神经病理学临床表现的个体差异。本研究调查了 CR 是否对中风后认知障碍和恢复具有调节作用。方法-本研究是对韩国中风队列功能和康复的中期分析。共有 7459 名首次中风的患者被纳入分析。教育、职业和从这两个变量得出的综合 CR 分数被用作 CR 代理。分析了中风发病后 30 个月内韩国版简易精神状态检查的分数。结果 - CR 较低会增加中风后认知障碍的风险。与受过高等教育的患者相比，受过中等教育的患者的比值比为 1.89（95% CI，1.64-2.19），而受过初等教育的患者的比值比为 2.42（95% CI，2.03-2.90）。与管理或专业职业的患者相比，熟练体力职业患者的优势比为 1.48（95% CI，1.23-1.98），非熟练体力职业患者的优势比为 2.01（95% CI，1.42-2.83）。在多级模型分析中，韩国版简易精神状态检查总分在前 3 个月内有所上升（每月 1.93 分），然后趋于稳定（每月 0.02 分）。斜率受到教育水平、职业和综合 CR 分数的调节：教育水平、职业或 CR 分数越高，恢复越快。在老年人组中，韩国版简易精神状态检查分数显示出长期下降，但受教育水平的影响有所缓和。结论-教育和职业可以缓冲个体因中风引起的认知障碍，并促进中风后早期快速认知恢复。此外，高等教育可以最大限度地减少中风后的长期认知能力下降，尤其是老年患者。
Background and Purpose- The theory of cognitive reserve (CR) was introduced to account for individual differences in the clinical manifestation of neuropathology. This study investigated whether CR has a modulating effect on cognitive impairment and recovery after stroke. Methods- This study is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 7459 patients with first-ever stroke were included for analysis. Education, occupation, and composite CR scores derived from those 2 variables were used as CR proxies. Scores from the Korean version of the Mini-Mental State Examination analyzed for 30 months after stroke onset were analyzed. Results- Lower CR increased the risk of cognitive impairment after stroke. The odds ratio was 1.89 (95% CI, 1.64-2.19) in patients with secondary education and 2.42 (95% CI, 2.03-2.90) in patients with primary education compared with patients with higher education. The odds ratio was 1.48 (95% CI, 1.23-1.98) in patients with a skilled manual occupation and 2.01 (95% CI, 1.42-2.83) in patients with a nonskilled manual occupation compared with patients with a managerial or professional occupation. In the multilevel model analysis, the Korean version of the Mini-Mental State Examination total score increased during the first 3 months (1.93 points per month) and then plateaued (0.02 point per month). The slopes were moderated by the level of education, occupation, and composite CR score: the higher the level of education, occupation, or CR score, the faster the recovery. In the older adult group, the Korean version of the Mini-Mental State Examination scores showed a long-term decline that was moderated by education level. Conclusions- Education and occupation can buffer an individual against cognitive impairment caused by stroke and promote rapid cognitive recovery early after stroke. In addition, higher education minimizes long-term cognitive decline after stroke, especially in older patients.