Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Stroke. 2013 Jul;44(7):1866-71. doi: 10.1161/STROKEAHA.113.001460. Epub 2013 May 16.
Predictive value of the conventional risk factors for stroke attenuates with age. Cognitive impairment has been implicated as a potential predictor for stroke in older subjects. Our aim was to compare the Framingham stroke risk score with cognitive functioning for predicting first-time stroke in a cohort of the oldest old individuals.
We included 480 subjects, aged 85 years, from the Leiden 85-plus Study. At baseline, data on the Framingham stroke risk score and the Mini-Mental State Examination (MMSE) score were obtained. Risk of first-time stroke was estimated in tertiles of Framingham and MMSE scores. Receiver operating characteristic curves with corresponding areas under the curves (AUCs) and 95% confidence intervals (CIs) were constructed for both Framingham and MMSE scores.
Subjects with high Framingham risk score compared with those with low Framingham risk score did not have a higher risk of stroke (hazard ratio, 0.77; 95% CI, 0.39-1.54). Conversely, subjects with high levels of cognitive impairment compared with those with low levels of cognitive impairment had a higher risk of stroke (hazard ratio, 2.85; 95% CI, 1.48-5.51). In contrast to the Framingham risk score (AUCs, 0.48; 95% CI, 0.40-0.56), MMSE score had discriminative power to predict stroke (AUCs, 0.65; 95% CI, 0.57-0.72). There was a significant difference between AUCs for Framingham risk score and MMSE score (P=0.006).
In the oldest old, the Framingham stroke risk score is not predictive for first-time stroke. In contrast, cognitive impairment, as assessed by MMSE score, identifies subjects at higher risk for stroke.
传统的中风危险因素对中风的预测价值随年龄的增长而减弱。认知障碍已被认为是老年患者中风的潜在预测因素。我们的目的是比较Framingham 中风风险评分与认知功能，以预测一个最年长的队列中首次中风的发生。
我们纳入了来自莱顿 85 岁以上研究的 480 名 85 岁的受试者。在基线时，获得了Framingham 中风风险评分和简易精神状态检查（MMSE）评分的数据。Framingham 和 MMSE 评分的三分位数用于估计首次中风的风险。绘制了 Framingham 和 MMSE 评分的受试者工作特征曲线及其相应的曲线下面积（AUC）和 95%置信区间（CI）。
与低Framingham 风险评分相比，高Framingham 风险评分的受试者并未增加中风的风险（危险比，0.77；95%CI，0.39-1.54）。相反，与认知功能低水平的受试者相比，认知功能高水平的受试者中风的风险更高（危险比，2.85；95%CI，1.48-5.51）。与 Framingham 风险评分（AUCs，0.48；95%CI，0.40-0.56）相比，MMSE 评分具有预测中风的判别能力（AUCs，0.65；95%CI，0.57-0.72）。Framingham 风险评分和 MMSE 评分的 AUC 之间存在显著差异（P=0.006）。
在最年长的老年人中，Framingham 中风风险评分不能预测首次中风。相反，MMSE 评分评估的认知障碍可以识别中风风险较高的患者。
