EPIDEMIOLOGIC STUDY OF THE RISK OF DEMENTIA AFTER STROKE

中风后痴呆风险的流行病学研究

• 批准号: 2431162
• 负责人: DAVID W DESMOND
• 金额: $ 80.97万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1988
• 资助国家: 美国
• 起止时间: 1988-07-01 至 1999-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2431162
• 关键词: brain disorder diagnosis; cerebral degeneration; cerebral ischemia /hypoxia; cerebrovascular disorder diagnosis; cognition disorders; computed axial tomography; dementia; diagnosis quality /standard; disease /disorder proneness /risk; early diagnosis; embolism; human subject; hypertension; longitudinal animal study; neuropsychological tests; relapse /recurrence; sign /symptom; stroke

Cerebrovascular disease (CVD) is considered the second most common cause of mental deterioration in th elderly. Unlike Alzheimer's disease, CVD is treatable. During the first study period, the Stroke and Aging Research Project accomplished its aims to determine the prevalence, incidence, and risk factors for dementia related to stroke, resulting in new information not previously available. The central goals of our proposed continuation are to extend prior findings on risk factors and course using longitudinal studies (Aims l and 2) and to examine new questions on syndromic profiles and anatomic risks using cross-sectional studies (Aims 3 and 4). First, we will identify risk factors for incident dementia in stroke patients initially nondemented at baseline by continued followup of the original cohorts (n=500) and assembly of a new stroke sample (n=300). In our prior study, power was sufficient to identify risk factors based on cross- sectional analysis, but suboptimal for incidence studies. Analysis of existing longitudinal data indicates that power will be sufficient in the proposed study to test the primary hypothesis that cerebral atrophy and recurrent stroke increase the risk of incident dementia. Other factors will be examined as secondary hypotheses. Second, we will characterize the course of cognitive function after stroke. In our prior study, most stroke patients showed a stable or improving course, while some patients showed cognitive decline. The extended followup and larger sample will allow us to test the hypothesis that cardiac disease at baseline is associated with a steeper slope of decline in test scores in some patients. Third, we will examine deficits in executive or frontal lobe function in the new stroke- sample and test the hypothesis that these deficits are more frequent in patients with subcortical compared to cortical infarcts on CT scan. Impaired executive function is considered to be a common manifestation of dementia from subcortical stroke; however, syndrome specificity in relation to lesion type has not been examined in a large stroke cohort. Fourth, we will evaluate an anatomic risk factor for dementia in a subgroup of the new sample with subcortical infarcts and test the hypothesis that involvement of the caudate, anterior capsule-genu, or thalamus is associated with an increased risk of dementia at stroke onset compared to other subcortical locations. In our prior study, some patients presented with a frontal lobe syndrome and dementia from isolated capsular genu infarction, justifying the term "strategic-infarct dementia". Functional imaging suggested that cortical disconnection was a mechanism for dementia, resulting from damage to structures that project to the frontal lobe. Our new anatomic studies will establish the strength of the association. Although dementia is a frequent and disabling consequence of CVD in our rapidly aging population, few studies have examined these issues. Information on syndromes and anatomic risk factors will improve diagnostic precision and clarify pathophysiology. Information on risk factors and course will have preventive implications and may assist in the design of clinical trials aimed at delaying cognitive deterioration. from CVD.

脑血管疾病 (CVD) 被认为是第二大常见原因 老年人精神恶化。与阿尔茨海默氏病不同，CVD 可治疗的。在第一个研究期间，中风和衰老研究 项目实现了确定患病率、发生率和 与中风相关的痴呆症危险因素，产生新信息 以前不可用。我们提议的延续的中心目标 是使用纵向扩展先前关于风险因素和过程的发现 研究（目标 1 和 2）并研究有关症状特征的新问题 以及使用横断面研究的解剖学风险（目标 3 和 4）。首先，我们 将确定中风患者发生痴呆的危险因素 通过继续跟踪最初的情况，最初在基线时没有痴呆 队列（n = 500）和新中风样本的组装（n = 300）。在我们之前的 研究表明，有足够的力量来识别基于交叉的风险因素 截面分析，但对于发病率研究来说不是最佳的。分析 现有的纵向数据表明，电力将充足 提出的研究旨在检验脑萎缩和 复发性中风会增加患痴呆症的风险。其他因素 将作为次要假设进行检验。其次，我们将描述 中风后认知功能的过程。在我们之前的研究中，大多数中风 患者的病程稳定或好转，而一些患者则表现出 认知能力下降。延长的后续行动和更大的样本将使我们能够 检验基线心脏病与以下因素相关的假设： 一些患者的测试成绩下降幅度更大。第三，我们将 检查新中风中执行或额叶功能的缺陷 抽样并检验这些缺陷在以下国家更常见的假设： CT 扫描中皮质下梗塞患者与皮质下梗塞患者的比较。 执行功能受损被认为是以下疾病的常见表现： 皮质下中风引起的痴呆；然而，综合征的特异性 尚未在大型卒中队列中研究与病变类型的关系。 第四，我们将评估痴呆症的解剖学危险因素 皮层下梗死的新样本的亚组并测试 假设尾状核、膝前囊或 丘脑与中风发作时患痴呆症的风险增加有关 与其他皮层下位置相比。在我们之前的研究中，一些患者 出现额叶综合征和孤立性囊性痴呆 膝部梗塞，证明了“策略性梗塞性痴呆”这一术语的合理性。 功能成像表明皮质断开是一种机制 对于痴呆症，由于投射到身体的结构损坏而导致 额叶。我们新的解剖学研究将确定 协会。 尽管痴呆症是心血管疾病在我们国家常见的致残性后果 人口迅速老龄化，很少有研究探讨这些问题。 有关综合征和解剖学危险因素的信息将改善诊断 精确并阐明病理生理学。有关风险因素的信息和 课程将具有预防意义，并可能有助于设计 旨在延缓认知衰退的临床试验。来自CVD。