浙江地区缺血性脑卒中患者早期认知功能障碍的检出率及危险因素分析
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摘要
目的:探索缺血性卒中患者早期认知功能障碍(early post-stroke cognitive impairment,ePSCI)检出率和危险因素。方法:基于中国大陆东部浙江省三级医院住院患者的多中心登记研究。纳入起病2周内的缺血性卒中患者,利用ADS-cog和CDR量表评估认知功能以及HAMD量表评估抑郁情绪。根据DSM-IV标准诊断e PSCI,包括卒中后轻度认知功能障碍(Poststrokemild cognitiveimpairment, psMCI)及卒中后痴呆(poststroke dementia, psDEM)。应用Logitic回归分析psMCI和psDEM危险因素。结果:共948例缺血性卒中患者纳入统计。ePSCI检出率是58.6%。教育是psMCI(OR=0.918(0.873-0.964), P=0.001)和psDEM(OR=0.815(0.742-0.895), P<0.000)保护因素。年龄是psMCI(OR=1.047(1.022-1.072), P<0.000)和psDEM(OR=1.096(1.051-1.143), P<0.000)危险因素。心血管疾病史是psMCI危险因素(OR=1.859(1.006-3.435),P=0.048)。抑郁是psMCI(OR=1.067(1.015-1.121), P=0.011)和psDEM(OR=1.266(1.162-1.380), P<0.000)危险因素。结论:缺血性卒中患者ePSCI检出率高达50%以上。长年限教育是保护因素,高龄、卒中前工作、心血管疾病史和抑郁情绪是危险因素。
Background Early post-stroke cognitive impairment(ePSCI) was often overlooked in clinical practice. Our aim was to identify the incidence and risk factors for ePSCI in patients with ischemic stroke. Methods Patients who had ischemic stroke in the last 2 weeks were included. Cognitive function was evaluated by the Alzheimer's Disease Assessment Scale-Cognitive subscale(ADAS-Cog).ePSCI including post-stroke mild cognitive impairment(psMCI) and post-stroke dementia(psDEM) was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)criteria. Logistic regression analysis was used to analyze the risk factors for psMCI and psDEM. Results 948 patients were included. The incidence of ePSCI was 58.6%. Education was a protective factor for psMCI(OR=0.918(0.873-0.964), P=0.001) and for ps DEM(OR=0.815(0.742-0.895), P<0.000). Age was a risk factor for psMCI(OR=1.047(1.022-1.072), P<0.000) and for psDEM(OR=1.096(1.051-1.143), P<0.000), as well as history of cardiovascular diseases(CVD) for psMCI(OR=1.859(1.006-3.435), P=0.048), depression for psMCI(OR=1.067(1.015-1.121), P=0.011) and for ps DEM(OR=1.266(1.162-1.380), P<0.000). Conclusion The incidence of ePSCI in patients with ischemic stroke was greater than 50%. Long period of education is a protective factor, while age, employment, history of cardiovascular diseases, and depression are risk factors.
Background Early post-stroke cognitive impairment(ePSCI) was often overlooked in clinical practice. Our aim was to identify the incidence and risk factors for ePSCI in patients with ischemic stroke. Methods Patients who had ischemic stroke in the last 2 weeks were included. Cognitive function was evaluated by the Alzheimer's Disease Assessment Scale-Cognitive subscale(ADAS-Cog).ePSCI including post-stroke mild cognitive impairment(psMCI) and post-stroke dementia(psDEM) was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)criteria. Logistic regression analysis was used to analyze the risk factors for psMCI and psDEM. Results 948 patients were included. The incidence of ePSCI was 58.6%. Education was a protective factor for psMCI(OR=0.918(0.873-0.964), P=0.001) and for ps DEM(OR=0.815(0.742-0.895), P<0.000). Age was a risk factor for psMCI(OR=1.047(1.022-1.072), P<0.000) and for psDEM(OR=1.096(1.051-1.143), P<0.000), as well as history of cardiovascular diseases(CVD) for psMCI(OR=1.859(1.006-3.435), P=0.048), depression for psMCI(OR=1.067(1.015-1.121), P=0.011) and for ps DEM(OR=1.266(1.162-1.380), P<0.000). Conclusion The incidence of ePSCI in patients with ischemic stroke was greater than 50%. Long period of education is a protective factor, while age, employment, history of cardiovascular diseases, and depression are risk factors.
引文
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[13]Sarah T Pendlebury,Ping-Jen Chen,Sarah JV Welch,Fiona C Cuthbertson,Rose M Wharton,Ziyah Mehta,Peter M Rothwell,and FMedSci for the Oxford Vascular Study.Methodological factors in determining risk of dementia after TIA and stroke:(II)impact of attrition on follow-up.Stroke.2015 June;46(6):1494-1500
[14]Mirza SS,Portegies ML,Wolters FJ,Hofman A,Koudstaal PJ,Tiemeier H,Ikram MA.Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA.The Rotterdam Study.Neuroepidemiology.2016;46(2):120-7
[15]Arba F,Quinn T,Hankey GJ,Inzitari D,Ali M,Lees KR;VISTA Collaboration.Determinants of post-stroke cognitive impairment:analysis from VISTA.Acta Neurol Scand.2016 Jul 13.
[16]Saira Saeed Mirza,Marileen L.P.Portegies,Frank J.Wolters,Albert Hofman,Peter J.Koudstaal,Henning Tiemeier,M.Arfan Ikram.Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA.The Rotterdam Study.Neuroepidemiology 2016;46:120-127
[17]Cordell CB,Borson S,Boustani M,Chodosh J,Reuben D,Verghese J,Thies W,Fried LB;Medicare Detection of Cognitive Impairment W.Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting.Alzheimers Dement.2013;9:141-150.
[18]Santangeli P,Di Biase L,Bai R,Mohanty S,Pump A,Cereceda Brantes M,Horton R,Burkhardt JD,Lakkireddy D,Reddy YM,Casella M,Dello Russo A,Tondo C,Natale A.Atrial fibrillation and the risk of incident dementia:a meta-analysis.Heart Rhythm.2012;9:1761-1768.
[19]Lin Cao,Sean D.Pokorney,Kathleen Hayden,Kathleen Welsh-Bohmer,L.Kristin Newby.Cognitive Function:Is There More to Anticoagulation in Atrial Fibrillation Than Stroke?J Am Heart Assoc.2015;4:e001573
[2]曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价.《中华老年心脑血管病杂志》2013,15(12):1294-1301
[3]Connor DJ,Sabbagh MN.Administration and scoring variance on the ADAS-Cog.J Alzheimers Dis.2008Nov;15(3):461-4.
[4]Leucht S,Fennema H,Engel R,Kaspers-Janssen M,Lepping P,Szegedi A.What does the HAMD mean?JAffect Disord.2013 Jun;148(2-3):243-8.
[5]Jacquin A,Binquet C,Rouaud O,Graule-Petot A,Daubail B,Osseby GV,Bonithon-Kopp C,Giroud M,Béjot Y.Post-Stroke Cognitive Impairment:High Prevalence and Determining Factors in a Cohort of Mild Stroke.J Alzheimers Dis.2014;40(4):1029-38.
[6]Arauz A,Rodríguez-Agudelo Y,Sosa AL,Chávez M,Paz F,González M,Coral J,Díaz-Olavarrieta C,Román GC.Cerebrovasc Dis.Vascular Cognitive Disorders and Depression After First-Ever Stroke:The Fogarty-Mexico Stroke Cohort.2014;38(4):284-9.
[7]Akinyemi RO,Allan L,Owolabi MO,Akinyemi JO,Ogbole G,Ajani A,Firbank M,Ogunniyi A,Kalaria RN.Profile and determinants of vascular cognitive impairment in African stroke survivors:the CogFASTNigeria Study.J Neurol Sci.2014 Nov 15;346(1-2):241-9.
[8]Liu L,Wang D,Wong KS,Wang Y.Stroke and Stroke Care in China.Huge Burden,Significant Workload,and a National Priority.Stroke.2011 Dec;42(12):3651-4.
[9]Pendlebury ST,Klaus SP,Thomson RJ,Mehta Z,Wharton RM,Rothwell PM;Oxford Vascular Study.Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack andStroke:(Ⅲ)Applicability of Cognitive Tests.Stroke.2015 Nov;46(11):3067-73.
[10]Sarah T.Pendlebury,Stephen P.Klaus,Ross J.Thomson,Ziyah Mehta,Rose M.Wharton,Peter M.Rothwell,for the Oxford Vascular Study.Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke(III)Applicability of Cognitive Tests.Stroke.2015;46:3067-3073
[11]Sarah T Pendlebury,Ping-jen Chen,Linda Bull,Louise Silver,Ziyah Mehta,and Peter M Rothwell,FMedSci for the Oxford Vascular Study.Methodological factors in determining rates of dementia in TIA and stroke:(Ⅰ)impact of baseline selection bias.Stroke.2015 March;46(3):641-646.
[12]Mehool Patel,Catherine Coshall,Anthony G Rudd,Charles DA Wolfe.Natural history of cognitive impairment after stroke and factors associated with its recovery.Clinical Rehabilitation 2003;17:158-166
[13]Sarah T Pendlebury,Ping-Jen Chen,Sarah JV Welch,Fiona C Cuthbertson,Rose M Wharton,Ziyah Mehta,Peter M Rothwell,and FMedSci for the Oxford Vascular Study.Methodological factors in determining risk of dementia after TIA and stroke:(II)impact of attrition on follow-up.Stroke.2015 June;46(6):1494-1500
[14]Mirza SS,Portegies ML,Wolters FJ,Hofman A,Koudstaal PJ,Tiemeier H,Ikram MA.Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA.The Rotterdam Study.Neuroepidemiology.2016;46(2):120-7
[15]Arba F,Quinn T,Hankey GJ,Inzitari D,Ali M,Lees KR;VISTA Collaboration.Determinants of post-stroke cognitive impairment:analysis from VISTA.Acta Neurol Scand.2016 Jul 13.
[16]Saira Saeed Mirza,Marileen L.P.Portegies,Frank J.Wolters,Albert Hofman,Peter J.Koudstaal,Henning Tiemeier,M.Arfan Ikram.Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA.The Rotterdam Study.Neuroepidemiology 2016;46:120-127
[17]Cordell CB,Borson S,Boustani M,Chodosh J,Reuben D,Verghese J,Thies W,Fried LB;Medicare Detection of Cognitive Impairment W.Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting.Alzheimers Dement.2013;9:141-150.
[18]Santangeli P,Di Biase L,Bai R,Mohanty S,Pump A,Cereceda Brantes M,Horton R,Burkhardt JD,Lakkireddy D,Reddy YM,Casella M,Dello Russo A,Tondo C,Natale A.Atrial fibrillation and the risk of incident dementia:a meta-analysis.Heart Rhythm.2012;9:1761-1768.
[19]Lin Cao,Sean D.Pokorney,Kathleen Hayden,Kathleen Welsh-Bohmer,L.Kristin Newby.Cognitive Function:Is There More to Anticoagulation in Atrial Fibrillation Than Stroke?J Am Heart Assoc.2015;4:e001573