Wagle Jørgen, Farner Lasse, Flekkøy Kjell, Wyller Torgeir Bruun, Sandvik Leiv, Eiklid Kristin L, Fure Brynjar, Stensrød Brynhild, Engedal Knut
Faculty of Medicine, University of Oslo, Oslo, Norway.
Dement Geriatr Cogn Disord. 2009;27(6):525-33. doi: 10.1159/000223230. Epub 2009 Jun 4.
The understanding of the contribution of genetic factors to cognitive impairment after stroke is incomplete. The aim of the study was to examine whether the apolipoprotein E epsilon4 allele (ApoE epsilon4) is a risk factor for cognitive impairment in the early phase after stroke.
The sample comprised 152 Norwegian stroke rehabilitation inpatients (mean age 76.8 years, SD 10.5) examined at a mean of 18.3 days (SD 13.4) after hospital admission. Post-stroke cognitive impairment was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The following proposed risk factors were analysed: ApoE genotype, demographics (age, sex, education), pre-stroke cognitive reduction [Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)], pre-stroke vascular factors (including previous stroke), stroke characteristics (type, location), and neurological stroke-related impairment [National Institutes of Health Stroke Scale (NIHSS)]. Cognitive impairment was defined as an RBANS total index score < or =1.5 SD below the mean. Multiple logistic regression analyses were performed to find risk factors for post-stroke cognitive impairment.
Four variables were found to be independent risk factors for cognitive impairment after stroke: ApoE epsilon4 (OR = 3.7; 95% CI = 1.2-11.6), IQCODE score > or =3.44 (OR = 9.2; 95% = CI 2.3-37.2), total or partial anterior stroke syndromes (OR = 3.2; 95% CI = 1.3-8.0), and NIHSS total score >5 (OR = 7.3; 95% CI = 2.7-19.7). No association between ApoE epsilon4 and pre-stroke cognitive reduction (IQCODE) was found.
The presence of one or two ApoE epsilon4 alleles may be a significant independent risk factor for cognitive impairment in the early phase after stroke.
目前对遗传因素在卒中后认知障碍中所起作用的认识尚不完整。本研究旨在探讨载脂蛋白Eε4等位基因（ApoEε4）是否为卒中后早期认知障碍的危险因素。
样本包括152名挪威卒中康复住院患者（平均年龄76.8岁，标准差10.5），于入院后平均18.3天（标准差13.4）接受检查。采用可重复性神经心理状态评估量表（RBANS）评估卒中后认知障碍。对以下提出的危险因素进行分析：ApoE基因型、人口统计学特征（年龄、性别、教育程度）、卒中前认知减退[老年人认知功能减退知情者问卷（IQCODE）]、卒中前血管因素（包括既往卒中）、卒中特征（类型、部位）以及与卒中相关的神经功能缺损[美国国立卫生研究院卒中量表（NIHSS）]。认知障碍定义为RBANS总指数得分低于平均值1.5个标准差及以上。进行多因素logistic回归分析以寻找卒中后认知障碍的危险因素。
发现有四个变量是卒中后认知障碍的独立危险因素：ApoEε4（比值比=3.7；95%置信区间=1.2 - 11.6）、IQCODE得分≥3.44（比值比=9.2；95%置信区间=2.3 - 37.2）、完全性或部分性前循环卒中综合征（比值比=3.2；95%置信区间=1.3 - 8.0）以及NIHSS总分>5（比值比=7.3；95%置信区间=2.7 - 19.7）。未发现ApoEε4与卒中前认知减退（IQCODE）之间存在关联。
存在一个或两个ApoEε4等位基因可能是卒中后早期认知障碍的重要独立危险因素。
