Tang Wai Kwong, Chan Sandra S M, Chiu Helen F K, Ungvari Gabor S, Wong Ka Sing, Kwok Timothy C Y, Mok Vincent, Wong K T, Richards Polly S, Ahuja A T
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
Stroke. 2004 Apr;35(4):930-5. doi: 10.1161/01.STR.0000119752.74880.5B. Epub 2004 Feb 19.
Both dementia and stroke are major health problems in Chinese societies. Stroke is a frequent cause of dementia. Only a few studies have been published on poststroke dementia (PSDE), none of which has investigated a consecutive stroke cohort in Asian patient populations. The objective of this study was to examine the prevalence and clinical correlates of PSDE in Chinese stroke patients in Hong Kong.
Two hundred eighty stroke patients consecutively admitted to the medical wards of a university-affiliated regional hospital were interviewed by a psychiatrist 3 months after stroke. The presence of dementia and vascular dementia was diagnosed according to the Diagnostic and Statistical Manual, 4th edition. In addition, a wide range of demographic and clinical variables were examined.
Fifty-five participants (20%) had PSDE. Univariate analysis found that PSDE was associated with age; level of education; prestroke Rankin Scale score; prestroke Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score; National Institutes of Health Stroke Scale (NIHSS) best language score, dysarthria score, and total score; urinary incontinence; cortical infarct; leukoaraiosis; bilateral lesions; number of lesions; involvement of middle cerebral artery circulation; and cerebral atrophy index. Multivariate logistic regression suggested that prestroke IQCODE score, NIHSS total score, leukoaraiosis, involvement of middle cerebral artery territory, and cerebral atrophy index were independent risk factors of PSDE. After removal of 22 patients with prestroke dementia, which was defined as a prestroke IQCODE score > or =4.0, the frequency of PSDE dropped to 15.5%. Furthermore, involvement of the middle cerebral artery territory and cerebral atrophy index were replaced by level of education and bilateral lesions as independent predictors in the final logistic model.
PSDE is common among Chinese stroke patients in Hong Kong. Its frequency is comparable to that in white populations. The clinical determinants of PSDE, after the exclusion of patients with prestroke dementia, include premorbid level of cognitive function, severity of stroke, leukoaraiosis, level of education, and bilateral lesions.
痴呆和中风都是中国社会的主要健康问题。中风是痴呆的常见病因。关于中风后痴呆（PSDE）的研究仅有少数发表，且均未对亚洲患者群体中的连续中风队列进行调查。本研究的目的是探讨香港中国中风患者中PSDE的患病率及其临床相关因素。
一所大学附属地区医院内科病房连续收治的280例中风患者在中风后3个月接受了精神科医生的访谈。根据《精神疾病诊断与统计手册》第4版诊断痴呆和血管性痴呆。此外，还检查了一系列人口统计学和临床变量。
55名参与者（20%）患有PSDE。单因素分析发现，PSDE与年龄、教育程度、中风前Rankin量表评分、中风前老年人认知功能下降知情者问卷（IQCODE）评分、美国国立卫生研究院中风量表（NIHSS）最佳语言评分、构音障碍评分和总分、尿失禁、皮质梗死、脑白质疏松、双侧病变、病变数量、大脑中动脉循环受累以及脑萎缩指数有关。多因素逻辑回归分析表明，中风前IQCODE评分、NIHSS总分、脑白质疏松、大脑中动脉区域受累以及脑萎缩指数是PSDE的独立危险因素。在排除22例中风前痴呆患者（定义为中风前IQCODE评分≥4.0）后，PSDE的发生率降至15.5%。此外，在最终的逻辑模型中，大脑中动脉区域受累和脑萎缩指数被教育程度和双侧病变所取代，成为独立预测因素。
PSDE在香港的中国中风患者中很常见。其发生率与白种人群相当。排除中风前痴呆患者后，PSDE的临床决定因素包括病前认知功能水平、中风严重程度、脑白质疏松、教育程度和双侧病变。
