Nakano Yumiko, Deguchi Kentaro, Yamashita Toru, Morihara Ryuta, Matsuzono Kosuke, Kawahara Yuko, Sato Kota, Kono Syoichiro, Hishikawa Nozomi, Ohta Yasuyuki, Higashi Yasuto, Takao Yoshiki, Abe Koji
Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Neurology, Himeji Central Hospital, Himeji, Japan.
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1621-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.037. Epub 2015 Apr 22.
This study investigated the incidence of current poststroke dementia (PSD), the annual conversion ratio into PSD, and the risk factors for conversion.
In a 4.8-year follow-up period, 112 poststroke patients (ischemic stroke and intracerebral hemorrhage) were retrospectively investigated in cognitive examinations. They were categorized into 3 subgroups: converters into PSD, nonconverters who maintained their normal cognitive functions, and reverters who recovered to the normal mentality range. The clinical and demographic characteristics of these 3 subgroups were analyzed.
Among all 112 poststroke patients (61.6% male, 73.6 ± 10.4 years old), 16.1% had PSD. During the follow-up period, a part of the normal baseline mentality group (83.9% of 112 original patients) newly developed PSD (subdivided into converters) with an annual conversion rate of 7.6%. The reversion rate from the baseline PSD group was 11.3%. There were significant differences in age (P < .05), baseline mini-mental state examination scores (P < .05), body mass index (P < .05), and periventricular and deep white matter hyperintensity grades (P < .05 and P = .01, respectively) between converters and nonconverters. The annual rate of stroke recurrence was only 2.2% in all stroke subtypes.
In comparison with stroke recurrence (2.2%), 7.6% of the annual PSD conversion rate was very high. Therefore, prevention of direct conversion into PSD without stroke recurrence may be another important aspect of poststroke clinics, especially in late elder society.
本研究调查了目前卒中后痴呆（PSD）的发病率、每年转化为PSD的转化率以及转化的危险因素。
在4.8年的随访期内，对112例卒中后患者（缺血性卒中和脑出血）进行了认知检查的回顾性研究。他们被分为3个亚组：转化为PSD的患者、维持正常认知功能的未转化者以及恢复到正常精神状态范围的恢复者。分析了这3个亚组的临床和人口统计学特征。
在所有112例卒中后患者中（男性占61.6%，年龄73.6±10.4岁），16.1%患有PSD。在随访期间，一部分基线精神状态正常的组（112例原始患者中的83.9%）新发生了PSD（细分为转化者），年转化率为7.6%。基线PSD组的恢复率为11.3%。转化者和未转化者在年龄（P<.05）、基线简易精神状态检查得分（P<.05）、体重指数（P<.05）以及脑室周围和深部白质高信号分级（分别为P<.05和P=.01）方面存在显著差异。所有卒中亚型的年卒中复发率仅为2.2%。
与卒中复发率（2.2%）相比，每年7.6%的PSD转化率非常高。因此，预防无卒中复发直接转化为PSD可能是卒中后临床的另一个重要方面，尤其是在老年晚期社会。
