You Shoujiang, Wang Xia, Lindley Richard I, Robinson Thompson, Anderson Craig S, Cao Yongjun, Chalmers John
Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, China.
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Cerebrovasc Dis. 2017;44(5-6):320-324. doi: 10.1159/000481443. Epub 2017 Oct 26.
Data on cognitive impairment after acute intracerebral hemorrhage (ICH) are limited. This study is aimed at determining the frequency and predictors of cognitive impairment among participants of the pilot phase, Intensive Blood Pressure (BP) Reduction in Acute Cerebral Hemorrhage Trial (INTERACT1).
INTERACT1 was an open randomized trial of early intensive (target systolic BP <140 mm Hg) compared with contemporaneous guideline-recommended BP lowering in 404 patients with elevated systolic BP (150-220 mm Hg) within 6 h of ICH onset. Cognitive impairment was defined by scores ≤24 on the Mini-Mental State Examination (MMSE) assessed by interview on follow-up at 90 days.
A total of 231 (64.5%) of 358 90-day survivors had MMSE scores for analyses, and 75 (32.5%) had cognitive impairment. In multivariable analysis, older age (OR 2.48, 95% CI 1.73-3.56 per 10-year increase; p < 0.001), female sex (OR 2.06, 95% CI 1.00-4.23; p = 0.049), prior ICH (OR 2.87, 95% CI 1.08-7.65; p = 0.035), high baseline National Institute of Health Stroke Scale score (OR 1.06, 95% CI 1.00-1.13; p = 0.044), and high mean systolic BP over the first 24 h post-randomization (OR 1.34, 95% CI 1.07-1.68/10 mm Hg increase; p = 0.011) were independently associated with cognitive impairment.
One third of patients have significant cognitive impairment early after ICH, which is more frequent in the elderly, females, those with prior ICH, and more severe initial neurological deficit and with persistently high early systolic BP.
急性脑出血（ICH）后认知障碍的数据有限。本研究旨在确定急性脑出血强化降压试验（INTERACT1）试点阶段参与者中认知障碍的发生率及其预测因素。
INTERACT1是一项开放随机试验，将404例脑出血发病6小时内收缩压升高（150 - 220 mmHg）的患者分为早期强化降压组（目标收缩压<140 mmHg）和同期指南推荐的降压组。认知障碍通过随访90天时访谈评估的简易精神状态检查表（MMSE）评分≤24分来定义。
358例90天幸存者中共有231例（64.5%）有MMSE评分用于分析，其中75例（32.5%）有认知障碍。在多变量分析中，年龄较大（每增加10岁，比值比[OR] 2.48，95%置信区间[CI] 1.73 - 3.56；p < 0.001）、女性（OR 2.06，95% CI 1.00 - 4.23；p = 0.049）、既往脑出血（OR 2.87，95% CI 1.08 - 7.65；p = 0.035）、基线美国国立卫生研究院卒中量表评分较高（OR 1.06，95% CI 1.00 - 1.13；p = 0.044）以及随机分组后最初24小时内平均收缩压较高（每升高10 mmHg，OR 1.34，95% CI 1.07 - 1.68；p = 0.011）与认知障碍独立相关。
三分之一的患者在脑出血后早期有明显的认知障碍，在老年人、女性、既往有脑出血者以及初始神经功能缺损更严重且早期收缩压持续较高的患者中更常见。
