Nuffield Department of Clinical Neurosciences, Stroke Prevention Research Unit, University of Oxford, Oxford, UK.
Int J Stroke. 2012 Oct;7(7):570-81. doi: 10.1111/j.1747-4949.2012.00837.x. Epub 2012 Jul 11.
Stroke is a risk factor for dementia and dementia predisposes to stroke. Dementia prevalence in subjects with stroke is comparable with that seen in stroke-free subjects who are 10 years older. Although overall there is heterogeneity between studies of prestroke and poststroke dementia, stratifying by study method and clinical criteria (e.g. inclusion/exclusion of prestroke dementia, first ever vs. any vs. recurrent stroke) results in reasonably consistent estimates. Pooled dementia rates from studies of consecutive patients hospitalized with stroke indicate that around 10% have dementia prior to first stroke and 10% have new dementia in the first year after first-ever stroke with highest rates (over 30%) seen after recurrent stroke. After the immediate high-risk poststroke period, rates of new incident dementia are lower but remain elevated at around four times the background risk. Factors associated with prestroke and poststroke dementia are broadly similar but age, medial temporal lobe atrophy, female sex, and family history are more strongly associated with prestroke dementia suggesting a greater role for degenerative pathology. Poststroke dementia is associated with factors indicating a reduced cognitive reserve (prestroke cognitive decline, premorbid disability, low education, white matter disease, and atrophy) and is also strongly associated with stroke factors (lesion size, multiple lesions, and stroke recurrence) and complications of stroke (delirium, seizures, hypotension, systemic illness and incontinence) indicating the likely impact of optimal acute stroke care and secondary prevention in reducing the burden of dementia. Future studies are needed to clarify the interaction between degenerative, vascular, and systemic processes in the development of stroke-associated dementia.
中风是痴呆的一个危险因素，而痴呆也会增加中风的风险。中风患者的痴呆患病率与年龄大 10 岁、无中风的患者相当。尽管在中风前和中风后痴呆的研究之间存在总体异质性，但按研究方法和临床标准（如是否包括中风前痴呆、首次中风或任何中风后的复发）进行分层，结果相当一致。对连续住院中风患者进行的研究中汇总的痴呆发生率表明，约 10%的患者在首次中风前患有痴呆，约 10%的患者在首次中风后的第一年发生新的痴呆，复发中风的发生率最高（超过 30%）。在中风后的即刻高危期过后，新发痴呆的发生率较低，但仍处于较高水平，是背景风险的四倍左右。与中风前和中风后痴呆相关的因素大致相似，但年龄、内侧颞叶萎缩、女性和家族史与中风前痴呆的相关性更强，这表明退行性病变的作用更大。中风后痴呆与表明认知储备降低的因素有关（中风前认知下降、发病前残疾、低教育程度、白质疾病和萎缩），也与中风因素（病灶大小、多个病灶和中风复发）以及中风并发症（谵妄、癫痫、低血压、全身性疾病和尿失禁）密切相关，这表明优化急性中风护理和二级预防在降低痴呆负担方面的重要性。需要进一步的研究来阐明退行性、血管性和系统性过程在中风相关痴呆发病中的相互作用。
