LONGITUDINAL STUDY ON STROKE RECURRENCE AND DEVELOPMENT OF DEMENTIA

1)为了探讨无症状脑血管疾病患者认知能力下降的危险因素，我们在6年中每3年进行一次MRI检查和认知功能测试。研究对象为31名老年人（平均年龄72岁），无脑疾病（包括中风）病史。它们都是独立的。他们在检查开始时、3年后和6年后分别接受了3次MRI检查。我们比较了3组患者的MRI表现，并评估白质病变或无症状性梗死是否增加。其中16名受试者在核磁共振成像上表现出无声的恶化，他们也表现出Okabe记忆量表的下降。与MRI未恶化组相比，本组血压升高。6年内脑血流量无变化。正常老年人认知功能的潜在下降与无症状梗死或白质病变的亚临床恶化有关。这种下降的风险因素是血压升高…2)研究135例脑梗死患者脑卒中复发与血压控制的关系。卒中复发率在发病后12个月内占43.3%，24个月内占70%。腔隙性梗死患者血压组呈J曲线趋势。舒张压最低值80 ~ 85 mmHg，高血压组差异有统计学意义。我们认为高血压控制不完全是卒中复发的危险因素。3)为了探讨脑卒中的遗传危险因素，我们研究了74例症状性脑梗死患者和214例对照者的MTHFR中与同型半胱氨酸代谢相关的Lp (a)表型和基因型多态性。多因素logistic分析显示Lp (a)表型（OR 3.98）和MTHFR （OR 2.75）是卒中的显著危险因素。我们还在我院147例接受脑部检查的患者中研究了这种多态性。结果表明，Lp (a)是无症状性脑梗死的重要危险因素（OR为1.53）。4)结论高血压是脑卒中复发的最大危险因素，认知功能下降与无症状脑血管疾病增加有关。Lp (a)的表型也是无症状性脑梗死的危险因素。少

1) To investigate risk factors for cognitive decline in the subjects with silent cerebrovascular diseases, we performed MRI examination and cognitive function test every 3 years during 6years. The subjects were 31 elderly people (mean age were 72 years old) without past history of cerebral diseases including stroke. They were all independent in ADL.They received MRI 3 times at starting of examination, 3 years after and 6 years after. We compared MRI findings among 3 sets, and evaluated whether white matter lesion or silent infarct did increase or not. Sixteen subjects of these showed silent worsening on MRI, and they showed also decline in Okabe memory scale. Blood pressure elevated in this group comparing with non-worsening MRI group. Cerebral blood flow did not change during 6years. Latent decline of cognitive functions in normal elderly related to subclinical worsening of silent infarction or white matter lesions on MRI.And the risk factor for this decline is elevation of blood pres … More sure.2) We studied the relationship between stroke recurrence and controlling of blood pressure in 135 patients with brain infarction. Stroke recurrence mostly occurred as 43.3% within 12 months from initial onset, and as 70% within 24 months. A tendency of J curve phenomenon in blood pressure groups was observed in the patients with lacunar infarction. Nadir of diastolic pressure was 80-85 mmHg, but significant difference was observed only with higher blood pressure group. We conclude incomplete control of hypertension is a risk factor for stroke recurrence.3) To investigate genetic risk factors for stroke, we studied phenotype of Lp (a) and polymorphism of genotype in MTHFR which related to metabolism of homocystein in the 74 patients with symptomatic brain infarction and 214 controls. Multivariate logistic analysis revealed Lp (a) phenotype (OR 3.98) and MTHFR (OR 2.75) were significant risk factors for stroke. We also studied these polymorphism in the 147 subjects who received brain check-up in our SIHS.This results showed that Lp (a) was significant risk factor for silent brain infarction (OR 1.53).4) ConclusionThese results indicate that hypertension is the greatest risk factor for stroke recurrence and decline of cognitive functions related to increase of silent cerebrovascular diseases. Phenotype of Lp (a) is also a risk factor for silent brain infarction. Less