Swartz Richard H, Bayley Mark, Lanctôt Krista L, Murray Brian J, Cayley Megan L, Lien Karen, Sicard Michelle N, Thorpe Kevin E, Dowlatshahi Dar, Mandzia Jennifer L, Casaubon Leanne K, Saposnik Gustavo, Perez Yael, Sahlas Demetrios J, Herrmann Nathan
University of Toronto, Toronto, Canada Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada Hurvitz Brain Sciences Research Program, Toronto, Canada Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Canada University of Toronto Stroke Program, Toronto, Canada
University of Toronto, Toronto, Canada Department of Medicine (Physiatry), University Health Network, Toronto Rehabilitation Institute, Toronto, Canada.
Int J Stroke. 2016 Jul;11(5):509-18. doi: 10.1177/1747493016641968. Epub 2016 Apr 12.
Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment ("DOC"). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA.
中风可导致从轻度到重度的神经功能损害，但中风的影响不仅限于最初的脑损伤，还包括一系列严重合并症的复杂相互作用，这些合并症包括：中风后抑郁症、阻塞性睡眠呼吸暂停和认知障碍（“DOC”）。我们回顾了每种DOC病症的发生频率、影响及治疗选择。然后，我们使用渥太华研究应用模型来检查护理方面的差距，了解知识转化、识别和处理这些重要中风后合并症的障碍。即使在考虑了传统血管危险因素之后，每种DOC病症都很常见，并且会导致恢复较差、功能障碍加剧、中风复发和死亡率增加。尽管DOC合并症与这些负面结果之间存在密切关系，并且有几个国家根据最佳实践建议提出了筛查建议，但它们经常未得到评估。与筛查工具的性质（例如，在高流量诊所中耗时）、实践环境（例如，缺乏人力资源或空间）以及潜在采用者（例如，对这些病症治疗益处的平衡）相关的障碍对常规筛查的实施构成了挑战。需要简单可行的常规筛查方法以及适当的循证治疗方案，以更好地识别和管理中风预防门诊患者的抑郁症、阻塞性睡眠呼吸暂停和认知障碍症状，从而减轻这些重要中风后合并症的影响。这些工具反过来可能有助于开展针对DOC病症干预措施的大规模随机对照治疗试验，这可能有助于改善中风或短暂性脑缺血发作后的心血管结局。
