What causes increased stroke mortality in patients with prestroke dementia?
What causes increased stroke mortality in patients with prestroke dementia?
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DOI：
10.1159/000084690
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发表时间：
2005-01-01
影响因子：
2.9
通讯作者：
Viitanen, M
中科院分区：
文献类型：
--
作者：
Appelros, P;Viitanen, M
背景和目的：痴呆患者中，卒中的发生率较高，且卒中更严重和致命。这项以人群为基础的研究的目的是描述既往痴呆对卒中患者死亡率的影响。方法：受试者均为≥ 65岁且在1年内首次发生卒中的患者（n = 327）。中风前痴呆（PSD）的诊断是在中风诊断时使用的数据从近亲和病人的记录。对患者进行前瞻性随访，并对死亡原因进行评价。结果：PSD患者28天病死率为44%，非PSD患者为15%。1年时的相应比率分别为71%和36%。28%的PSD患者在第一年内发生了新的卒中，而非PSD患者为8%。PSD组中更多的患者死于卒中的直接或间接后果。多变量分析显示，除了年龄、房颤和中风严重程度之外，PSD也是死亡率的独立预测因素。结论：PSD患者更常发生卒中相关死亡，即使我们调整了一些其他因素。其原因很可能是多因素的，包括急性期感染并发症的倾向增加和医源性原因。PSD患者的大脑也可能比非痴呆的大脑更脆弱，更容易受到缺血性或出血性损伤。版权所有（C）2005 S. Karger AG，巴塞尔。
Background and Purpose: In patients with dementia, the incidence of stroke is higher and strokes are more severe and lethal. The purpose of this population-based study was to describe in what way previous dementia affects mortality in stroke patients. Methods: Subjects were all persons >= 65 years old who had a first-ever stroke during 1 year (n = 327). The prestroke dementia (PSD) diagnosis was made at the time of the stroke diagnosis using data from next of kin and from patient records. Patients were followed prospectively and causes of death were evaluated. Results: The 28-day case fatality was 44% for PSD patients and 15% for non-PSD patients. Corresponding ratios at 1 year were 71 and 36%, respectively. Twenty-eight percent of the PSD patients had a new stroke during the first year, compared to 8% of the non-PSD patients. More patients in the PSD group died as a direct or indirect consequence of their stroke. Multivariate analysis showed that PSD, in addition to age, atrial fibrillation and stroke severity, was an independent predictor of mortality. Conclusions: The PSD patients more often had a stroke-related death, even when we adjusted for a number of other factors. The cause for this is most likely multifactorial, including an increased tendency to contract complications in the acute phase, and iatrogenic causes. The brain of the PSD patients may also be frailer and more susceptible to ischemic or hemorrhagic damage than the nondemented brain. Copyright (C) 2005 S. Karger AG, Basel.