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EPIDEMIOLOGIC STUDY OF THE RISK OF DEMENTIA AFTER STROKE

中风后痴呆风险的流行病学研究

基本信息

批准号：
6291425
负责人：
DAVID W DESMOND
金额：
$ 20.32万
依托单位：
SUNY DOWNSTATE MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
1988
资助国家：
美国
起止时间：
1988-07-01 至 2001-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6291425
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

项目摘要

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)被认为是第二常见的原因老年人精神衰退的可能性。与阿尔茨海默病不同的是，心血管疾病是可以治疗的。在第一个研究阶段，中风与衰老的研究项目实现了其目标，以确定流行率、发病率和与中风有关的痴呆症的危险因素，导致新的信息以前不可用的。我们提议的延续的中心目标是扩展先前关于风险因素和病程的发现，使用纵向研究(目标L和2)并探讨证候谱上的新问题和使用横断面研究的解剖风险(目标3和4)。首先，我们将确定中风患者发生痴呆症的危险因素最初在基线时没有精神错乱，继续跟踪原始队列(n=500)和组装新的卒中样本(n=300)。在我们之前的研究表明，基于交叉试验的能力足以识别风险因素。分段分析，但对于发病率研究来说不是最好的。分析现有的纵向数据表明，电力将足够在建议进行一项研究，以检验大脑萎缩和反复中风会增加痴呆症发生的风险。其他因素将作为次要假设进行研究。第二，我们将描述卒中后认知功能的变化。在我们之前的研究中，大多数中风患者的病程稳定或有所改善，而部分患者则表现为认知能力下降。更广泛的跟踪和更大的样本将使我们能够来检验基线水平的心脏病与一些患者的测试分数下降的斜率更大。第三，我们将检查新中风患者的执行或额叶功能缺陷- 抽样并检验这样的假设，即这些缺陷在皮质下梗死组与皮质梗死组的CT扫描结果比较。执行功能受损被认为是一种常见的皮质下卒中所致痴呆；然而，与病变类型的关系尚未在大型卒中队列中进行研究。第四，我们将评估痴呆症的一个解剖危险因素有皮质下梗塞的新样本的亚组并测试假设受累于尾状、膝前囊膜或丘脑与中风发病时痴呆症风险增加有关与其他皮质下位置相比。在我们之前的研究中，一些患者表现为额叶综合征和孤立囊性痴呆膝部梗塞，证明了“策略性梗死性痴呆”这一术语的合理性。功能成像显示，大脑皮质连接中断是一种机制对于痴呆症来说，是由于突出到额叶。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的常见和致残后果，但在我们的在人口迅速老龄化的今天，很少有研究研究这些问题。有关症状和解剖风险因素的信息将改善诊断精确和明确的病理生理学。关于风险因素和课程将具有预防意义，并可能有助于设计旨在延缓认知退化的临床试验。来自心血管疾病。