Oveisgharan Shahram, Hachinski Vladimir
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States; Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Clinical Neurological Sciences, University Hospital, University of Western Ontario, London, ON, Canada.
J Neurol Sci. 2015 Feb 15;349(1-2):161-7. doi: 10.1016/j.jns.2015.01.010. Epub 2015 Jan 13.
Although stroke is known to result in executive dysfunction, little is known about executive dysfunction as a risk factor for stroke.
Canadian Study of Health and Aging (CSHA), a longitudinal population based study of elderly Canadians, was conducted in three waves in 1990-1991 (CSHA-1), 1995-1996 (CSHA-2), and 2001-2002 (CSHA-3). In a cross-sectional analysis on CSHA-1 subjects, any association between stroke history and cognitive function was studied. In a prospective analysis, CSHA-1 stroke-free subjects were followed to CSHA-2 to see if there was any difference in stroke incidence among subjects with different baseline cognitive status. And, in a validation study CSHA-2 stroke-free subjects were followed to CSHA-3 to see if the prospective analyses findings could be replicated.
In the cross-sectional analysis, subjects who had stroke in their history had significantly lower executive function, not memory function, scores than subjects without any stroke in their history. In the prospective and validation studies, stroke incidence was affected by neither executive nor memory scores. When the analysis was restricted to normal cognition subjects, lower executive function, not memory function, scores predicted stroke incidence, and remained significant after controlling for stroke risk factors.
We found executive dysfunction to be a powerful stroke risk factor among cognitively normal subjects. Testing for executive dysfunction may help identify individuals at risk for stroke in time to prevent them.
尽管已知中风会导致执行功能障碍，但关于执行功能障碍作为中风风险因素的情况却知之甚少。
加拿大健康与老龄化研究（CSHA）是一项基于人群的对加拿大老年人的纵向研究，于1990 - 1991年（CSHA - 1）、1995 - 1996年（CSHA - 2）和2001 - 2002年（CSHA - 3）分三个阶段进行。在对CSHA - 1受试者的横断面分析中，研究了中风病史与认知功能之间的任何关联。在前瞻性分析中，对CSHA - 1中无中风的受试者随访至CSHA - 2，以观察不同基线认知状态的受试者中风发病率是否存在差异。并且，在一项验证研究中，对CSHA - 2中无中风的受试者随访至CSHA - 3，以观察前瞻性分析结果是否能够被重复验证。
在横断面分析中，有中风病史的受试者执行功能得分显著低于无中风病史的受试者，而记忆功能得分则不然。在前瞻性和验证性研究中，中风发病率既不受执行功能得分也不受记忆功能得分的影响。当分析仅限于认知正常的受试者时，较低的执行功能得分而非记忆功能得分可预测中风发病率，并且在控制中风风险因素后仍然显著。
我们发现执行功能障碍是认知正常受试者中一个强有力的中风风险因素。检测执行功能障碍可能有助于及时识别中风高危个体并加以预防。
