Neuroimaging predictors of death and dementia in a cohort of older stroke survivors.
Neuroimaging predictors of death and dementia in a cohort of older stroke survivors.
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DOI：
10.1136/jnnp-2011-300873
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发表时间：
2012-03
期刊：
影响因子：
--
通讯作者：
Kalaria RN
中科院分区：
文献类型：
--
作者：
Firbank MJ;Allan LM;Burton EJ;Barber R;O'Brien JT;Kalaria RN
中风是随后死亡和痴呆的危险因素。能够识别处于特定风险中的受试者将有益于告知治疗和患者管理。招募了年龄超过75岁的卒中患者。受试者在卒中后3个月进行认知评估以排除痴呆，并在当时进行MRI扫描（n=106）。 然后纵向跟踪受试者的痴呆和/或死亡事件。痴呆存活的独立神经影像学预测因子是内侧颞叶萎缩（MTA; p=0.013）和丘脑梗死（p=0.002）。在模型中纳入认知评分后，MTA（p=0.049）和丘脑梗死（p=0.04）的显著性降低，通过基线认知评分（p=0.004）最佳预测生存期。存活至死亡的唯一独立显著预测因子是MTA。除丘脑梗死外，NINDS/AIREN神经影像学标准不能独立预测死亡或痴呆的生存率。MTA与较短的痴呆时间相关，表明阿尔茨海默病病理学在卒中后痴呆的发展中起作用。
Stroke is a risk factor for subsequent death and dementia. Being able to identify subjects at particular risk would be beneficial to inform treatment and patient management. Subjects aged over 75 years with incident stroke were recruited. Subjects had a cognitive assessment at 3 months post stroke to exclude dementia, and had an MRI scan (n=106) at that time. Subjects were then followed longitudinally for incident dementia and/or death. Independent neuroimaging predictors of survival to dementia were medial temporal atrophy (MTA; p=0.013) and the presence of thalamic infarcts (p=0.002). After inclusion of cognitive score in the model, the significance of MTA (p=0.049) and thalamic infarcts (p=0.04) was reduced, with survival being best predicted by baseline cognitive score (p=0.004). The only independent significant predictor of survival to death was MTA. Apart from thalamic infarcts, the NINDS/AIREN neuroimaging criteria did not independently predict survival to death or dementia. MTA was associated with shorter time to dementia, suggesting a role for Alzheimer pathology in the development of post stroke dementia.
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