Poststroke dementia -: Influence of hippocampal atrophy
Poststroke dementia -: Influence of hippocampal atrophy
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DOI：
10.1001/archneur.60.4.585
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发表时间：
2003-04-01
影响因子：
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通讯作者：
Leys, D
中科院分区：
文献类型：
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作者：
Cordoliani-Mackowiak, MA;Hénon, H;Leys, D
背景：卒中后痴呆的患病率增加。内侧颞叶萎缩（MTLA）与阿尔茨海默病有关，并与中风患者的中风前痴呆有关。目的：为了确定MTLA对中风后痴呆的长期风险的影响，排除中风前dementia.Methods的患者后：本研究进行了144例连续中风患者，谁是年龄40岁或以上（66名女性和78名男性;中位年龄，72岁），和谁有一个知情人问卷调查认知下降的老年人得分低于104。入院时，所有患者均接受了包括颞叶定位切片在内的非对比计算机断层扫描。使用11.5 mm的临界值来区分MTLA患者和无MTLA患者。患者随访3年以上的临床和认知评估。结果：中风后3年，34例（23.6%）新发痴呆。MTLA患者中无痴呆存活者的累积比例为57.6%，无MTLA患者为80.8%（P= 0.02）。与MTLA相关的卒中后痴呆的未校正相对危险度为2.3（95%置信区间，1.1-4.7）。然而，使用考克斯比例风险模型，MTLA似乎不是卒中后痴呆的独立预测因子。中风后痴呆的独立预测因素是年龄的增加，糖尿病，严重程度的临床赤字在入院时，和严重程度的leukoaraiosis on computed tomography.Conclusions：患者中风和MTLA更频繁地发展痴呆症比患者没有MTLA，但我们的研究并不表明，MTLA独立有助于痴呆症。可能需要更长时间的随访来重新评估MTLA的影响。
Background: The prevalence of dementia is increased after stroke. Medial temporal lobe atrophy (MTLA) is associated with Alzheimer disease, and with prestroke dementia in patients who have had a stroke..Objective: To determine the influence of MTLA on the long-term risk of dementia after stroke, after excluding the patients who had prestroke dementia.Methods: The study was conducted in 144 consecutive patients who had a stroke, who were aged 40 years or older (66 women and 78 men; median age, 72 years), and who had an informant Questionnaire on Cognitive Decline in the Elderly score lower than 104. On admission to the hospital all patients underwent a noncontrast computed tomographic scan including temporal lobe-positioned slices. A cut-off of 11.5 mm was used to differentiate patients with MTLA from those without MTLA. Patients were followed up with clinical and cognitive assessments over a 3-year period.Results: Three years after stroke, 34 patients (23.6%) had developed new-onset dementia. The cumulative proportion of survivors without dementia was 57.6% in patients with MTLA and 80.8% in patients without MTLA (P=.02). The unadjusted relative risk of poststroke dementia associated with MTLA was 2.3 (95% confidence interval, 1.1-4.7). However, using the Cox proportional hazards model, MTLA did not seem to be an independent predictor of poststroke dementia. Independent predictors of poststroke dementia were increasing age, diabetes mellitus, severity of the clinical deficit at admission, and severity of leukoaraiosis on computed tomography.Conclusions: Patients who had a stroke and MTLA more frequently develop dementia than patients without MTLA, but our study does not suggest that MTLA independently contributes to dementia. A longer follow-up may be necessary to reevaluate the influence of MTLA.