Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
Neurology. 2010 Feb 2;74(5):379-85. doi: 10.1212/WNL.0b013e3181ccc516.
Vascular risk factors are associated with ischemic changes in the cerebral white matter. We studied the predictive value of cognitive test performance especially related to subcortico-frontal pathways, together with a cognitive screening test, for later incidence of fatal or nonfatal stroke or TIAs and stroke subtypes.
A sample of 930 70-year-old men without previous stroke/TIA from the community-based Uppsala Longitudinal Study of Adult Men was investigated at baseline using Trail Making Tests (TMT) A and B and the Mini-Mental State Examination (MMSE).
During up to 13 years of follow-up, 166 men developed a stroke or TIA; 105 participants had a brain infarction. In Cox proportional hazards analyses adjusting for education, social group, and traditional cardiovascular risk factors, a 1-SD increase in TMT-B time was associated with a higher risk for brain infarction (hazard ratio 1.48, 95% confidence interval 1.11-1.97). The risk of brain infarction was more than threefold higher in the highest (TMT-B = 146-240 s) compared to the lowest (TMT-B = 43-84 s) TMT-B quartile. TMT-A and MMSE results were not consistently related to stroke outcomes.
Impaired performance in elderly men measured by Trail Making Test B, a cognitive test especially reflecting subcortico-frontal activities, was an independent predictor of subsequent brain infarction in this community-based sample of elderly men. Our results extend previous findings of cognitive decline as an independent predictor of stroke and indicate that the risk of brain infarction is increased already in the subclinical phase of cognitive deficit.
血管危险因素与脑白质的缺血性改变有关。我们研究了认知测试表现的预测价值，特别是与皮质下-额前通路相关的认知测试表现，以及认知筛查测试，以预测随后致命或非致命性中风或 TIA 以及中风亚型的发生。
我们在基线时使用连线测试（TMT）A 和 B 以及简易精神状态检查（MMSE）对来自社区为基础的乌普萨拉 70 岁男性纵向研究的 930 名无先前中风/TIA 的男性进行了研究。
在长达 13 年的随访期间，166 名男性发生了中风或 TIA；105 名参与者发生了脑梗死。在调整教育、社会群体和传统心血管危险因素后，Cox 比例风险分析显示 TMT-B 时间增加 1 个标准差与脑梗死风险增加相关（风险比 1.48，95%置信区间 1.11-1.97）。与 TMT-B 时间最低（TMT-B = 43-84 s）的四分位相比，TMT-B 时间最高（TMT-B = 146-240 s）的参与者发生脑梗死的风险高出三倍以上。TMT-A 和 MMSE 的结果与中风结果并不一致。
在这个基于社区的老年男性样本中，通过连线测试 B 测量的老年男性认知功能受损，是随后发生脑梗死的独立预测因素，这一结果扩展了之前认知衰退作为中风独立预测因素的发现，并表明在认知缺陷的亚临床阶段，脑梗死的风险已经增加。
