Department of Clinical Neurological Sciences, London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada.
Neuroepidemiology. 2010;35(3):215-20. doi: 10.1159/000315484. Epub 2010 Jul 27.
BACKGROUND/AIMS: Self-reported history of stroke has been questioned in the elderly due to the high prevalence of cognitive impairment. We tested the validity of response to a stroke questionnaire versus clinical diagnosis of stroke among elderly people with and without cognitive impairment.
Community-dwelling participants to the phase 1 Canadian Study of Health and Aging were screened for self-reported stroke. Physician-diagnosed stroke was set as the gold standard. The positive predictive value (PPV), sensitivity and specificity were determined.
1,536/ 1,659 (93%) participants aged 65 years and over had stroke information from both sources. Among stroke positive responders, the PPV was 81% overall: 76% for cognitively normal, 84% for cognitively impairment with no dementia (CIND), and 82% for demented. Among stroke diagnosed by physicians, history of stroke was reported by 38% cognitively normal, 54% CIND, and 55% demented. The specificity was over 97% in all cognitive categories.
Among community-dwelling elderly people, any cognitive impairment did not imply inaccurate self-reported history of stroke. High prevalence of stroke and frequent contacts with health services among cognitively-impaired elderly may increase the awareness of stroke symptoms and signs. Stroke increases the risk of developing dementia in both cognitively normal and CIND, and efforts to accomplish stroke prevention are justified, especially in these categories.
背景/目的：由于认知障碍的高发率，老年人的中风自述病史受到了质疑。我们检验了认知障碍和无认知障碍的老年人对中风问卷的回答与中风临床诊断之间的一致性。
参加第一阶段加拿大老龄化健康研究的社区居民接受了中风自我报告的筛查。医师诊断的中风作为金标准。确定了阳性预测值（PPV）、敏感性和特异性。
1659 名年龄在 65 岁及以上的参与者中，有 1536 名（93%）同时来自两个来源的中风信息。在中风阳性应答者中，总体 PPV 为 81%：认知正常者为 76%，无痴呆的认知障碍（CIND）者为 84%，痴呆者为 82%。在医师诊断的中风中，38%的认知正常者、54%的 CIND 者和 55%的痴呆者报告有中风史。在所有认知类别中，特异性均超过 97%。
在社区居住的老年人中，任何认知障碍都不意味着他们对中风病史的自述不准确。认知障碍老年人中风的高发病率和与卫生服务的频繁接触可能会增加对中风症状和体征的认识。中风增加了认知正常和 CIND 人群发展为痴呆的风险，因此有理由努力进行中风预防，尤其是在这些人群中。
