Jacova Claudia, Pearce Lesly A, Roldan Ana M, Arauz Antonio, Tapia Jorge, Costello Raymond, McClure Leslie A, Hart Robert G, Benavente Oscar R
Division of Neurology, School of Professional Psychology, Pacific University, Hillsboro, OR, USA.
Biostatistical Consultant, Minot, ND, USA.
Int J Stroke. 2015 Jun;10(4):519-28. doi: 10.1111/ijs.12511.
Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients.
The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients.
The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial.
Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ≤5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years = 1.52, confidence interval = 1.35-1.71), lower education (odds ratio 0-4 years = 1.23, confidence interval = 0.90-1.67), being a Latin American resident (odds ratio = 1.31, confidence interval = 0.87-1.98), and post-stroke disability (odds ratio Barthel Index <95 = 1.89, confidence interval = 1.43-2.50) were independently associated with mild cognitive impairment.
Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.
腔隙性卒中患者常出现认知障碍。讲西班牙语患者的认知障碍患病率及模式尚不清楚，且未在不同地区间进行比较，也未与讲英语的患者作比较。
本研究旨在描述讲西班牙语患者的认知障碍特征，并与讲英语的患者进行比较。
在小皮质下卒中二级预防试验中，对讲西班牙语患者的基线神经心理学测试表现以及轻度认知障碍的患病率进行了评估，轻度认知障碍定义为记忆和/或非记忆测试中的z分数≤ -1.5。
在3020名参与者中，有1177名是居住在拉丁美洲（n = 693）、美国（n = 121）和西班牙（n = 363）的讲西班牙语的患者。讲西班牙语的患者中低教育程度（零至八年）很常见（49 - 57%）。拉丁美洲讲西班牙语的患者卒中后上肢运动障碍很常见（83%）。与讲英语的患者相比，所有讲西班牙语的患者组记忆缺陷较小，非记忆/运动缺陷较大，拉丁美洲讲西班牙语的患者缺陷最大（非记忆测试中位数z分数为 -1.3至 -0.6；沟槽钉板测试≤5.0；记忆测试为 -0.7至 -0.3）。轻度认知障碍的患病率很高，在美国讲英语的患者和拉丁美洲讲西班牙语的患者中与讲英语的患者相当，但西班牙组不同：讲英语的患者为47%，拉丁美洲讲西班牙语的患者为51%，美国讲西班牙语的患者为40%，西班牙讲西班牙语的患者为29%，讲西班牙语的患者组中超过50%的患者表现为非遗忘型。年龄较大（每10岁的优势比 = 1.52，置信区间 = 1.35 - 1.71）、教育程度较低（0 - 4年的优势比 = 1.23，置信区间 = 0.90 - 1.67）、为拉丁美洲居民（优势比 = 1.31，置信区间 = 0.87 - 1.98）以及卒中后残疾（巴氏指数<95的优势比 = 1.89，置信区间 = 1.43 - 2.50）与轻度认知障碍独立相关。
近期发生腔隙性卒中的小皮质下卒中二级预防试验中讲西班牙语患者的轻度认知障碍非常普遍，但模式与讲英语的患者不同。社会人口统计学、卒中生物学和卒中护理的综合因素可能解释了这些差异。
