Wang Qianyi, Mejía-Guevara Iván, Rist Pamela M, Walter Stefan, Capistrant Benjamin D, Glymour M Maria
Department of Epidemiology, University of California, San Francisco, Calif., USA.
Cerebrovasc Dis. 2014;37(4):235-43. doi: 10.1159/000357557. Epub 2014 Mar 25.
Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race.
Health and Retirement Study participants aged ≥50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age (≤70 vs. >70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change.
Older (>70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p < 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p < 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p < 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory.
Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease.
中风后记忆障碍在老年人、女性和黑人中更为常见。目前尚不清楚中风后的差异是反映了中风本身的不同影响，还是中风前功能的差异。我们按年龄、性别和种族比较中风前后的记忆轨迹。
对年龄≥50岁（n = 17341）、基线时无中风病史的健康与退休研究参与者，每两年进行一次访谈，为期10年，以了解首次自我报告或他人代报的中风情况（n = 1574）。采用分段线性回归模型比较1169名中风幸存者、405名中风死亡者和15767名未中风参与者中风前后的记忆变化年率。通过按基线年龄（≤70岁与>70岁）、性别和种族（白人与非白人）分层的分析，并使用年龄/性别/种族指标与年度记忆变化之间的交互项来评估效应修正。
老年人（>70岁）在中风前记忆衰退更快（幸存者为-0.19分/年对-0.10分/年，死亡者为-0.24分/年对-0.13分/年，两种交互作用的p均<0.001），与年轻人相比，中风幸存者在中风时记忆下降幅度更大（-0.64分对-0.26分，p<0.001），中风发作后记忆衰退更快（-0.15分/年对-0.07分/年，p = 0.003）。女性中风幸存者在中风前的记忆衰退比男性中风幸存者更快（-0.14分/年对-0.10分/年，p<0.001）。然而，在其他对比中未发现性别差异。虽然白人中风后的记忆得分高于非白人，但种族与任何时间段的记忆衰退率均无关联；即种族在中风前后并未显著改变衰退率，也未显著改变中风对记忆的即时影响。
年龄较大预示着中风发作前、发作时和发作后的记忆变化更差。中风后记忆结果的性别和种族差异可能归因于中风前的差异，这可能与脑血管疾病无关。
