Park Young Ho, Jang Jae-Won, Park So Young, Wang Min Jeong, Lim Jae-Sung, Baek Min Jae, Kim Beom Joon, Han Moon-Ku, Bae Hee-Joon, Ahn Soyeon, Kim SangYun
Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea.
J Stroke Cerebrovasc Dis. 2015 Mar;24(3):554-61. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.033. Epub 2014 Dec 19.
Cognitive impairment impedes stroke rehabilitation. However, it is unclear whether cognitive impairment of specific domains or the degree of severity is more critical to functional recovery in patients with poststroke disability.
We identified 182 patients who were disabled at 3 months after acute stroke, as defined by a modified Rankin Scale score of 2-5. At a single time point between 3 months and 1 year after onset, the following 4 cognitive domains were assessed: executive function, visuospatial ability, language, and memory. With respect to the severity of cognitive impairment, the patients were classified as having vascular dementia (VD), vascular cognitive impairment no dementia (VCIND), or normal cognition. The primary outcome was functional recovery between 3 months and 1 year after onset. To examine the association between cognitive status and functional recovery, multiple logistic regression with backward stepwise analysis was performed.
A total of 74 (40.7% of 182) patients demonstrated functional improvement at 1 year compared with 3 months. Patients with executive impairment demonstrated significantly less improvement in functional outcomes, with an adjusted odds ratio (OR) of .472 (95% confidence interval [CI], .245-.910). Patients with VD also demonstrated less functional recovery, with an adjusted OR of .289 (95% CI, .120-.700). The remaining 3 cognitive domains and VCIND were not significantly associated with functional recovery.
Executive function is a strong predictor of recovery from disability in patients with acute stroke. In addition, functional recovery is significantly hampered by cognitive impairment due to VD, but not VCIND.
认知障碍会阻碍中风康复。然而，尚不清楚特定领域的认知障碍或严重程度对中风后残疾患者的功能恢复是否更为关键。
我们确定了182例急性中风后3个月出现残疾的患者，根据改良Rankin量表评分为2 - 5来定义。在发病后3个月至1年之间的单个时间点，评估以下4个认知领域：执行功能、视觉空间能力、语言和记忆。关于认知障碍的严重程度，将患者分为患有血管性痴呆（VD）、非痴呆性血管性认知障碍（VCIND）或认知正常。主要结局是发病后3个月至1年之间的功能恢复。为了检验认知状态与功能恢复之间的关联，进行了带有向后逐步分析的多重逻辑回归。
与3个月时相比，共有74例（182例中的40.7%）患者在1年时功能得到改善。执行功能受损的患者在功能结局方面的改善明显较少，调整后的优势比（OR）为0.472（95%置信区间[CI]，0.245 - 0.910）。患有VD的患者功能恢复也较少，调整后的OR为0.289（95% CI，0.120 - 0.700）。其余3个认知领域和VCIND与功能恢复无显著关联。
执行功能是急性中风患者残疾恢复的有力预测指标。此外，VD所致的认知障碍会显著阻碍功能恢复，但VCIND不会。
