Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA.
Neurology. 2012 Sep 4;79(10):981-7. doi: 10.1212/WNL.0b013e31826845e9. Epub 2012 Aug 8.
The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.
We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.
Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03-5.92) and IADL impairment (OR 3.86, 95% CI 1.60-9.28).
Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.
本横断面研究旨在确定既往无卒中或 TIA 诊断的终末期肾病（ESRD）患者中卒中症状的患病率及其潜在意义。
我们从 5 个诊所招募了 148 名 ESRD 患者。通过验证后的问卷确定卒中症状和功能状态、基本和工具性日常生活活动（ADL、IADL）。使用神经认知成套测验评估认知功能。认知障碍定义为在 2 个领域中得分低于年龄和教育 2 个标准差。IADL 障碍定义为在至少 7 项 IADL 中有 1 项需要帮助。
在 126 名既往无卒中或 TIA 的参与者中，有 46 名（36.5%）经历过 1 次或多次卒中症状。在调整年龄、性别、种族、教育程度、语言、糖尿病和心血管疾病后，有卒中症状的参与者在注意力、精神运动速度和执行功能测试中的得分较低，并且在 IADL 和 ADL 中依赖程度更高（所有 p 值≤0.01）。在调整年龄、性别、种族、教育程度、语言、糖尿病和心血管疾病后，有卒中症状的参与者更有可能发生认知障碍（比值比[OR] 2.47，95%置信区间[CI] 1.03-5.92）和 IADL 障碍（OR 3.86，95% CI 1.60-9.28）。
卒中症状在 ESRD 患者中很常见，与认知和功能状态受损密切相关。这些发现表明，在这一高危人群中，临床上有意义的卒中事件可能被漏诊。
