Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry
Pre-Stroke Cholinesterase Inhibitor Treatment Is Beneficially Associated with Functional Outcome in Patients with Acute Ischemic Stroke and Pre-Stroke Dementia: The Fukuoka Stroke Registry
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中风前胆碱酯酶抑制剂治疗与急性缺血性中风和中风前痴呆患者的功能结果有益相关：福冈中风登记处
DOI：
10.1159/000514368
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发表时间：
2021
影响因子：
2.9
通讯作者：
on behalf of the Fukuoka Stroke Registry Investigators
中科院分区：
文献类型：
--
作者：
Wakisaka Yoshinobu;Matsuo Ryu;Nakamura Kuniyuki;Ago Tetsuro;Kamouchi Masahiro;Kitazono Takanari;on behalf of the Fukuoka Stroke Registry Investigators
卒中前痴呆与卒中预后不良显著相关。胆碱酯酶抑制剂（ChEIs）可能降低痴呆患者中风的风险。然而，脑卒中前ChEI治疗与脑卒中预后之间的关系仍未得到解决。因此，我们的目的是确定急性缺血性卒中和卒中前痴呆患者的这种关联。方法：在2007年6月至2019年5月期间在福冈卒中登记处登记的13167例发病7天内的缺血性卒中患者中，纳入805例卒中前痴呆患者，这些患者在入院前独立进行基本日常生活活动（adl）。主要和次要研究结果分别为卒中发作后3个月的功能预后差（改良Rankin量表[mRS]评分：3 - 6）和神经功能恶化（住院期间NIH卒中量表[NIHSS]评分≥2分）。采用Logistic回归分析评估脑卒中前ChEI治疗与研究结果之间的关系。为了改善协变量不平衡，我们进一步进行了倾向评分（PS）匹配的队列研究。结果212例（26.3%）接受脑卒中前ChEI治疗。在校正潜在混杂因素后，治疗与功能预后不良（优势比：0.68[95%可信区间：0.46-0.99]）和神经功能恶化（0.52[0.31-0.88]）呈负相关。在ps匹配的队列研究中，卒中前ChEI治疗与功能预后不良之间的趋势相同（0.61[0.40-0.92]），治疗与神经功能恶化之间的趋势相同（0.47[0.25-0.86]）。结论我们的研究结果表明，卒中前ChEI治疗与卒中前痴呆患者急性缺血性卒中后功能预后不良和神经系统恶化的风险降低相关，卒中前痴呆患者在卒中发作前独立于基本ADLs。
IntroductionPre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia.MethodsWe enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3–6) at 3 months after stroke onset and neurological deterioration (≥ 2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study.ResultsAmong the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46–0.99]) and neurological deterioration (0.52 [0.31–0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40–0.92]) and between the treatment and neurological deterioration (0.47 [0.25–0.86]).ConclusionsOur findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.