Jacquin Agnès, Binquet Christine, Rouaud Olivier, Graule-Petot Anny, Daubail Benoit, Osseby Guy-Victor, Bonithon-Kopp Claire, Giroud Maurice, Béjot Yannick
Memory Centre, Department of Neurology, University Hospital, University of Burgundy, Stroke Registry, Dijon, France.
Clinical Investigation Center, Clinical Epidemiology/Clinical Trials, University Hospital, Dijon, France.
J Alzheimers Dis. 2014;40(4):1029-38. doi: 10.3233/JAD-131580.
Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing.
To identify the factors associated with 3-month PSCI.
All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010 - February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MOCA). Patients assessable at 3 months were categorized as cognitively impaired if the MMSE score was ≤26/30 and MOCA <26/30 or if the neuropsychological battery confirmed PSCI when the MMSE and MOCA were discordant. Multivariable logistic models were used to determine factors associated with 3-month PSCI.
Among the 280 patients included, 220 were assessable at 3 months. The overall frequency of 3-month PSCI was 47.3%, whereas that of dementia was 7.7%. In multivariable analyses, 3-month PSCI was associated with age, low education level, a history of diabetes mellitus, acute confusion, silent infarcts, and functional handicap at discharge. MMSE and MOCA scores during hospitalization were associated with 3-month PSCI (OR = 0.63; 95% CI: 0.54-0.74; p < 0.0001 and OR = 0.67; 95% CI: 0.59-0.76; p < 0.0001, respectively).
Our study underlines the high frequency of PSCI in a cohort of mild stroke. The early cognitive diagnosis of stroke patients could be useful by helping physicians to identify those at a high risk of developing PSCI.
由于人口老龄化以及中风幸存者数量的增加，中风后认知障碍（PSCI）的患病率正在上升。
确定与3个月PSCI相关的因素。
纳入法国第戎大学医院神经科（2010年11月 - 2012年2月）收治的所有连续的无中风前痴呆、轻度认知障碍或严重失语的中风患者，进行这项前瞻性队列研究。收集人口统计学、血管危险因素和中风数据。住院期间使用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MOCA）进行首次认知评估。如果MMSE评分≤26/30且MOCA<26/30，或者当MMSE和MOCA结果不一致时神经心理成套测验确诊为PSCI，则3个月时可评估的患者被分类为认知障碍。使用多变量逻辑模型确定与3个月PSCI相关的因素。
在纳入的280例患者中，220例在3个月时可进行评估。3个月时PSCI的总体发生率为47.3%，而痴呆的发生率为7.7%。在多变量分析中，3个月时PSCI与年龄、低教育水平、糖尿病史、急性意识模糊、无症状性梗死和出院时的功能障碍相关。住院期间的MMSE和MOCA评分与3个月时的PSCI相关（OR分别为0.63；95%CI：0.54 - 0.74；p<0.0001和OR为0.67；95%CI：0.59 - 0.76；p<0.0001）。
我们的研究强调了轻度中风队列中PSCI的高发生率。中风患者的早期认知诊断可能有助于医生识别那些发生PSCI风险较高的患者。
