Pasquini M, Leys D, Rousseaux M, Pasquier F, Hénon H
Department of Neurology (Stroke Unit), Lille University Hospital, Lille, France.
J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):56-9. doi: 10.1136/jnnp.2006.102533. Epub 2006 Sep 4.
Pre-existing cognitive decline and new-onset dementia are common in patients with stroke, but their influence on institutionalisation rates is unknown.
To evaluate the influence of cognitive impairment on the institutionalisation rate 3 years after a stroke.
(1) The previous cognitive state of 192 consecutive patients with stroke living at home before the stroke (with the Informant Questionnaire on COgnitive Decline in the Elderly (IQCODE)), (2) new-onset dementia occurring within 3 years and (3) institutionalisation rates within 3 years in the 165 patients who were discharged alive after the acute stage were prospectively evaluated.
Independent predictors of institutionalisation over a 3-year period that were available at admission were age (adjusted odds ratio (adjOR) for 1-year increase = 1.08; 95% confidence interval (CI) 1.03 to 1.15), severity of the neurological deficit (adjOR for 1-point increase in Orgogozo score = 0.97; 95% CI 0.96 to 0.99) and severity of cognitive impairment (adjOR for 1-point increase in IQCODE score = 1.03; 95% CI 1 to 1.06). Factors associated with institutionalisation at 3 years that were present at admission or occurred during the follow-up were age (adjOR for 1-year increase = 1.17; 95% CI 1.07 to 1.27) and any (pre-existing or new) dementia (adjOR = 5.85; 95% CI 1.59 to 21.59), but not the severity of the deficit of the neurological deficit.
Age and cognitive impairment are more important predictors of institutionalisation 3 years after a stroke than the severity of the physical disability.
既往存在的认知功能减退和新发痴呆在卒中患者中很常见，但它们对机构化率的影响尚不清楚。
评估认知障碍对卒中后3年机构化率的影响。
（1）前瞻性评估192例在家中卒中前连续的卒中患者的既往认知状态（使用老年人认知功能减退知情者问卷（IQCODE）），（2）3年内新发痴呆情况，以及（3）急性期后存活出院的165例患者3年内的机构化率。
入院时可获得的3年机构化独立预测因素为年龄（年龄每增加1岁的调整优势比（adjOR）=1.08；95%置信区间（CI）1.03至1.15）、神经功能缺损严重程度（奥尔戈佐评分每增加1分的adjOR=0.97；95%CI 0.96至0.99）和认知障碍严重程度（IQCODE评分每增加1分的adjOR=1.03；95%CI 1至1.06）。入院时存在或随访期间出现的与3年机构化相关的因素为年龄（年龄每增加1岁的adjOR=1.17；95%CI 1.07至1.27）和任何（既往存在或新发）痴呆（adjOR=5.85；95%CI 1.59至21.59），但不是神经功能缺损的严重程度。
与身体残疾的严重程度相比，年龄和认知障碍是卒中后3年机构化更重要的预测因素。
