脑卒中幸存者的跌倒风险：脑卒中合并痴呆和运动功能容量降低的影响。
Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity.
机构信息
Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.
Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Neurol Sci. 2019 Jun 15;401:95-100. doi: 10.1016/j.jns.2019.04.035. Epub 2019 Apr 26.
BACKGROUND
Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia.
METHODS
Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models.
RESULTS
The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82).
CONCLUSION
Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.
背景
尽管针对脑卒中患者的跌倒问题已经进行了广泛的研究，但对于伴有合并症诊断和运动功能障碍的神经状况对这些患者跌倒风险的影响，我们知之甚少。因此，本研究旨在确定脑卒中、痴呆和脑卒中合并痴呆患者的跌倒风险，以及运动功能障碍降低对跌倒风险的影响。
方法
本横断面研究分析了全国健康老龄化趋势研究（NHATS）的数据，该研究是一项针对医疗保险受益人的全国代表性样本。采用逻辑回归模型，评估了三个神经疾病亚组（脑卒中[ n = 751]、痴呆[ n = 369]和脑卒中合并痴呆[ n = 141]）中自我报告的过去 1 个月内跌倒的可能性，并以无脑卒中/痴呆的个体（即对照组[ n = 6337]）为参照组。
结果
与对照组相比，三个神经障碍组的近期跌倒发生率明显更高（P <.05）。在调整了社会人口统计学因素、移动设备的使用以及其他合并症（即慢性疾病、视力障碍和大手术）后，与对照组相比，脑卒中（比值比[OR] = 1.45）、痴呆（OR = 2.45）和脑卒中合并痴呆（OR = 2.64）患者发生近期跌倒的可能性显著增加。进一步调整较低的运动功能障碍后，脑卒中患者的风险比有所降低（OR = 1.16）；然而，痴呆（OR = 1.67）和脑卒中合并痴呆（OR = 1.82）患者的风险仍显著升高。
结论
研究结果表明，伴有合并症痴呆的脑卒中幸存者跌倒的可能性增加。此外，运动功能障碍降低会增加脑卒中患者跌倒的可能性，但不足以解释痴呆或脑卒中合并痴呆患者跌倒可能性的增加。因此，关注痴呆的二级预防和改善运动功能的干预措施可能会降低脑卒中患者的跌倒风险。
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