Baseline cognitive function, recurrent stroke, and risk of dementia in patients with stroke.
Baseline cognitive function, recurrent stroke, and risk of dementia in patients with stroke.
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DOI：
10.1161/strokeaha.111.680728
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发表时间：
2013-07
期刊：
影响因子：
8.3
通讯作者：
Tzourio C
中科院分区：
文献类型：
--
作者：
Rist PM;Chalmers J;Arima H;Anderson C;Macmahon S;Woodward M;Kurth T;Tzourio C
确定基线MMSE与卒中史患者总体痴呆、复发性卒中后痴呆和无复发性卒中痴呆风险之间的相互关系。前瞻性队列研究纳入了培哚普利预防复发性卒中研究（PROGRESS）的参与者，他们的基线迷你精神状态检查（MMSE）评分是可用的。基线MMSE分为4类：30、29-27、26-24和<24。研究人员对参与者进行了痴呆和复发性中风的随访。Logistic回归模型用于检验MMSE与痴呆之间的关系。在本分析纳入的6080名参与者中，有2493人MMSE=30, 1768人MMSE= 29-28, 1369人MMSE= 26-24, 450人MMSE<24。平均随访时间为3.8年。共有407例痴呆症患者，其中106例患有复发性中风。总体痴呆的风险随着MMSE评分的降低而增加。然而，MMSE对无卒中复发性痴呆风险的影响远大于MMSE对卒中后复发性痴呆风险的影响。对于MMSE<24的患者，无卒中复发的痴呆风险为47.89 (95% CI: 28.57-80.26)，而卒中后复发痴呆风险仅为7.17 （95% CI: 3.70-13.89）。较高的MMSE得分与卒中后复发性痴呆的风险相关性更弱。低MMSE评分的脑卒中患者随着时间的推移，即使没有复发性脑卒中，也有较高的痴呆风险，因此应密切关注进一步的认知能力下降。
To determine the interrelationships between baseline MMSE and risk of overall dementia, post-recurrent stroke dementia and dementia without recurrent stroke among patients with a history of stroke. Prospective cohort study among participants enrolled in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) for whom baseline Mini-Mental State Examination (MMSE) score was available. Baseline MMSE was divided into four categories: 30, 29–27, 26–24, or <24. Participants were followed for incident dementia and recurrent stroke. Logistic regression models were used to examine the association between MMSE and dementia. Of the 6080 participants included in this analysis, 2493 had MMSE=30, 1768 had MMSE=29–28, 1369 had MMSE=26–24 and 450 had MMSE<24. Average follow-up time was 3.8 years. There were 407 cases of dementia, 106 of which were preceded by a recurrent stroke. The risk of overall dementia increased with decreasing MMSE score. However, the impact of MMSE on risk of dementia without recurrent stroke was much stronger than the impact of MMSE on the risk of post-recurrent stroke dementia. For those with MMSE<24, the risk of dementia without recurrent stroke was 47.89 (95% CI: 28.57–80.26) while the risk of post-recurrent stroke dementia was only 7.17 (95% CI: 3.70–13.89). Higher MMSE scores were even less strongly associated with the risk of post-recurrent stroke dementia. Stroke patients with low MMSE scores are at high risk of dementia over time, even in the absence of a recurrent stroke, and should therefore be followed closely for further cognitive decline.