Narasimhalu K, Ang S, De Silva D A, Wong M-C, Chang H-M, Chia K-S, Auchus A P, Chen C
Center for Molecular Epidemiology, National University of Singapore.
Neurology. 2009 Dec 1;73(22):1866-72. doi: 10.1212/WNL.0b013e3181c3fcb7.
The utility of poststroke cognitive status, namely dementia, cognitive impairment no dementia (CIND), mild cognitive impairment (MCI), and no cognitive impairment (NCI), in predicting dementia has been previously examined. However, no studies to date have compared the ability of subtypes of MCI and CIND to predict dementia in a poststroke population.
A cohort of ischemic stroke patients underwent neuropsychological assessment annually for up to 5 years. Dementia was defined using the DSM-IV criteria. Univariate and multivariable Cox proportional regression was performed to determine the ability of MCI subtypes, CIND severity, and individual domains of impairment to predict dementia.
A total of 362 patients without dementia were followed up for a mean of 3.4 years (17% drop out), with 24 developing incident dementia. Older age, previous and recurrent stroke, and CIND and MCI subtypes were significant predictors of dementia. In multivariable analysis controlling for treatment allocation, patients who were older, had previous or recurrent stroke, and had either CIND moderate or multiple domain MCI with amnestic component were at elevated risk for dementia. In multivariable domain analysis, recurrent strokes, age, and previous strokes, verbal memory, and visual memory were significant predictors of dementia. Receiver operating characteristic curve analysis showed that CIND moderate (area under the curve: 0.893) and multiple domain MCI with amnestic component (area under the curve: 0.832) were significant predictors of conversion to dementia. All other classifications of cognitive impairment had areas under the curve less than 0.7.
Stroke patients with cognitive impairment no dementia (CIND) moderate are at higher risk of developing dementia, while CIND mild patients are not at increased risk of developing dementia.
卒中后认知状态，即痴呆、非痴呆性认知障碍（CIND）、轻度认知障碍（MCI）和无认知障碍（NCI），在预测痴呆方面的效用此前已得到研究。然而，迄今为止尚无研究比较MCI和CIND亚型在预测卒中后人群痴呆方面的能力。
一组缺血性卒中患者每年接受神经心理学评估，最长达5年。使用《精神疾病诊断与统计手册》第四版（DSM-IV）标准定义痴呆。进行单变量和多变量Cox比例回归分析，以确定MCI亚型、CIND严重程度和个体损害领域预测痴呆的能力。
共有362例无痴呆患者接受了平均3.4年的随访（17%失访），其中24例发生了新发痴呆。年龄较大、既往有卒中史及复发性卒中、CIND和MCI亚型是痴呆的显著预测因素。在控制治疗分配的多变量分析中，年龄较大、有既往或复发性卒中且患有中度CIND或伴有遗忘成分的多领域MCI的患者发生痴呆的风险较高。在多变量领域分析中，复发性卒中、年龄、既往卒中史、言语记忆和视觉记忆是痴呆的显著预测因素。受试者工作特征曲线分析显示，中度CIND（曲线下面积：0.893）和伴有遗忘成分的多领域MCI（曲线下面积：0.832）是转化为痴呆的显著预测因素。所有其他认知障碍分类的曲线下面积均小于0.7。
中度非痴呆性认知障碍（CIND）的卒中患者发生痴呆的风险较高，而轻度CIND患者发生痴呆的风险并未增加。
