尽管采用了最先进的中风治疗方法,但中风后认知障碍的发生率和致残率仍然很高。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-10-01 Epub Date: 2024-03-21 DOI:10.1177/17474930241238637
Laura Gallucci, Christoph Sperber, Adrian G Guggisberg, Christoph P Kaller, Mirjam R Heldner, Andreas U Monsch, Arsany Hakim, Norbert Silimon, Urs Fischer, Marcel Arnold, Roza M Umarova
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引用次数: 0

摘要

背景:目的:在接受包括血管内治疗在内的现代最先进卒中治疗的患者队列中,我们评估了卒中后认知障碍的频率和特定领域认知障碍的模式,确定了卒中后认知障碍的风险因素,并确定了急性卒中后认知障碍对卒中结局的影响:在这项前瞻性单中心队列研究中,我们对症状发生后 10 天内首次发生前循环缺血性卒中且卒中前无认知功能下降的患者进行了全面的神经心理学评估。根据人口统计学变量对标准数据进行了分层。我们将 PSCI 定义为至少在 ≥ 2 个认知领域存在中度(< 1.5 SD)缺陷。多变量回归分析用于确定 PSCI 的风险因素:我们分析了 2020 年 12 月至 2023 年 7 月期间收治的 329 名非重症患者(67.2±14.4 岁,41.3% 为女性,13.1±2.7 年教育程度)。虽然大多数患者为轻度卒中(NIHSS 24h 中位数=1.00 [0.00; 3.00];87.5%的患者 NIHSS ≥ 5),但其中 69.3%的患者在卒中后 2.7±2.0 天出现 PSCI。受影响最严重和最常见的认知领域是言语学习、外显记忆、执行功能、选择性注意和建构能力(39.1%-51.2%的患者),而空间忽略较少见(18.5%)。受教育年限越长(几率比 [OR] 0.47,95% CI:0.23-0.99)、右半球病变(OR 0.47,95% CI:0.26-0.84),PSCI 的风险越低;中风严重程度(NIHSS 24h,OR 4.19,95% CI:2.72-6.45)、高脂血症(OR 1.93,95% CI:1.01-3.68)越高,PSCI 的风险越高,但不受年龄影响。在对卒中严重程度和抑郁症状进行调整后,急性 PSCI 与不良功能预后相关(改良 Rankin 量表 > 2,F=13.695,pF=20.069,pConclusions):尽管采用了现代中风治疗方法,且许多中风的严重程度较轻,但急性中风阶段的 PSCI 仍很常见,且与较差的预后有关。最常见的是学习和记忆障碍。以受教育年限为标准的认知储备可独立保护卒中后的认知能力。
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Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment.

Background: State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI).

Aims: In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome.

Methods: In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI.

Results: We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke.

Conclusion: Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
期刊最新文献
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