Makin Stephen Dj, Doubal Fergus N, Shuler Kirsten, Chappell Francesca M, Staals Julie, Dennis Martin S, Wardlaw Joanna M
1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Eur Stroke J. 2018 Jun;3(2):145-156. doi: 10.1177/2396987317750517. Epub 2018 Jan 8.
Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life.
We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1-3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke's Cognitive Examination-Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale).
We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56-74) years, 36/157 (23%) patients had a Addenbrooke's Cognitive Examination-Revised score < 82 at one to three months, 29/151 (19%) had a Addenbrooke's Cognitive Examination-Revised < 82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83).
This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease.
Pre-morbid intelligence should be considered in future studies of post-stroke cognition.
认知障碍会使轻度中风复杂化，但包括早年的峰值认知能力在内的风险因素方面的信息有限。
我们招募了有临床明显腔隙性或轻度非腔隙性缺血性中风的患者，记录临床特征、血管危险因素、磁共振成像检测到的中风亚型和小血管疾病负担。在中风后1 - 3个月和12个月时，我们评估了教育程度（受教育年限）、当前认知（修订版Addenbrooke认知检查）、病前智力（国家成人阅读测试）和依赖程度（改良Rankin量表）。
我们招募了157名患者（87例腔隙性中风，64例非腔隙性缺血性中风），中位年龄66岁（四分位间距56 - 74岁），36/157（23%）的患者在1至3个月时修订版Addenbrooke认知检查得分<82分，29/151（19%）的患者在1年时修订版Addenbrooke认知检查得分<82分。较低的国家成人阅读测试得分（国家成人阅读测试每降低一分认知障碍的比值比为0.91，95%置信区间为0.87，0.95）和较高年龄（每年的年龄比值比为1.04（95%置信区间为1.01，1.08））相比中风严重程度（国立卫生研究院卒中量表每分的比值比为0.96（95%置信区间为0.68，1.31））或血管危险因素如高血压（高血压诊断的比值比为0.52（95%置信区间为0.24，1.15））更能预测1年时的认知障碍。认知障碍与更多的白质高信号相关（Fazekas评分每增加一分的比值比为1.42，95%置信区间为1.11，1.83）。
这项观察性研究提供了证据表明病前智商和教育程度可预测中风后的认知，并证实了认知障碍与小血管疾病之间的关联。
在未来中风后认知的研究中应考虑病前智力。
