From the Stroke Unit and the Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel (E.B.A., S.-S.T., E.K., H.H., L.S., E.A., N.G., A. Mike, A.H., A.W., A. Mirelman, N.M.B.); and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.B.A., A.D.K., E.K., H.H., E.A., N.G., N.M.B., J.M.H.).
Stroke. 2015 Apr;46(4):1077-83. doi: 10.1161/STROKEAHA.114.007346. Epub 2015 Feb 12.
Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors.
Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event.
Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (P<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (P<0.001), slower gait (P<0.001), and fewer correct answers during dual-task walking (P=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36-27.15).
These results suggest that measures of balance and gait are significant risk markers of cognitive status 2 years after stroke. Relatively simple, performance-based tests of mobility may enhance the identification of stroke/transient ischemic attack survivors who have an increased risk of developing CD.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
中风患者有认知障碍的风险。我们测试了平衡和步态评估是否可以增强对中风幸存者长期认知结果的预测。
参与者来自特拉维夫大脑急性中风队列（TABASCO）研究中的首次轻度中度缺血性中风或短暂性脑缺血发作患者，这是一项大型前瞻性队列研究，他们在指数事件后 6、12 和 24 个月进行了 3-T MRI 检查，并进行了神经学、神经心理学和移动性检查，随访时间≥2 年。
共有 298 名患者（年龄：66.7±9.6 岁）的数据可用。46 名参与者（15.4%）在 2 年的随访中出现认知下降（CD）。CD 组和认知完整组在神经功能缺损或梗塞体积或位置上没有差异。尽管如此，中风后 6 个月，那些后来出现 CD 的人完成计时起立行走测试的时间更长（P<0.001）。此外，CD 组的 Berg 平衡量表评分也较低（P<0.001），步态较慢（P<0.001），双任务行走时正确答案较少（P=0.006）。对短暂性脑缺血发作患者的单独分析也得出了类似的结果。多变量回归分析显示，中风/短暂性脑缺血发作后 6 个月的计时起立行走时间>12 秒是中风后 24 个月 CD 的显著独立风险标志物（优势比=6.07，95%置信区间：1.36-27.15）。
这些结果表明，平衡和步态测量是中风后 2 年认知状态的重要风险标志物。相对简单的基于表现的移动性测试可能会增强识别中风/短暂性脑缺血发作幸存者的能力，这些患者发生 CD 的风险增加。
