Poststroke dementia is associated with recurrent ischaemic stroke
Poststroke dementia is associated with recurrent ischaemic stroke
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DOI：
10.1136/jnnp-2012-304084
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发表时间：
2013-07-01
影响因子：
11
通讯作者：
Erkinjuntti, Timo
中科院分区：
文献类型：
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作者：
Sibolt, Gerli;Curtze, Sami;Erkinjuntti, Timo
目的探讨缺血性脑卒中后脑卒中后痴呆（PSD）对缺血性脑卒中复发的预测作用。方法纳入赫尔辛基大学中心医院连续收治的缺血性脑卒中患者486例（其中首次脑卒中患者388例），随访12年。115例患者使用《精神障碍诊断与统计手册》第三版（DSM-III）标准诊断为痴呆。使用Kaplan-Meier对数秩分析估计危险因素和PSD对无卒中复发生存的影响，使用Cox比例风险模型计算卒中复发的hr。结果在整个队列中，PSD患者发生卒中复发的平均时间（7.13年，95% CI 6.20 ~ 8.06）短于无痴呆患者（9.41年，8.89 ~ 9.92年，log rank p < 0.001）。这一发现在首次卒中患者中也得到了证实（6.89年，5.85至7.93年vs 9.68年，9.12至10.24年；p < 0.001）。在Cox单因素分析中，在整个队列中（HR 2.02; 95% CI 1.47 - 2.77）和首次卒中患者中（2.40;1.68 - 3.42），PSD与卒中复发风险增加相关。在校正了年龄、心房颤动、外周动脉疾病和高血压等重要协变量后，在整个队列中（1.84；1.34至2.54）和首次卒中患者（2.16；1.51至3.10），PSD与卒中复发风险增加相关。结论脑卒中后痴呆对缺血性脑卒中复发有预测作用，在评估预后时应予以考虑。
Objective To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.Methods We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and PSD on survival free of recurrent stroke were estimated using Kaplan-Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models.Results In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p < 0.001). This finding was replicated in patients with first-ever stroke (6.89 years, 5.85 to 7.93 vs 9.68 years, 9.12 to 10.24; p < 0.001). In Cox univariate analysis, PSD was associated with increased risk for recurrent stroke both in the entire cohort (HR 2.02; 95% CI 1.47 to 2.77) and in those with first-ever stroke (2.40; 1.68 to 3.42). After adjustment for the significant covariates of age, atrial fibrillation, peripheral arterial disease and hypertension, PSD was associated with increased risk for recurrent stroke both in the entire cohort (1.84; 1.34 to 2.54) and in those with first-ever stroke (2.16; 1.51 to 3.10).Conclusions Poststroke dementia predicts recurrence of ischaemic stroke in long-term follow-up and should be considered when estimating prognosis.