McHutchison Caroline A, Chappell Francesca M, Makin Stephen, Shuler Kirsten, Wardlaw Joanna M, Cvoro Vera
Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh Bioquarter, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK.
Brain Sci. 2019 May 22;9(5):117. doi: 10.3390/brainsci9050117.
Considering premorbid or "peak" adult intelligence (IQ) is important when examining post-stroke cognition. The stability of estimated premorbid IQ and its relationship to current cognitive ability in stroke is unknown. We investigated changes in estimated premorbid IQ and current cognitive ability up to three years post-stroke. Minor stroke patients (NIHSS < 8) were assessed at one to three months, one and three years' post-stroke. The National Adult Reading Test (NART) and Addenbrooke's Cognitive Examination-Revised (ACE-R) were used to estimate premorbid IQ (NART IQ) and current cognitive ability respectively at each time-point. Baseline demographics, vascular and stroke characteristics were included. Of the 264 patients recruited (mean age 66), 158 (60%), 151 (57%), and 153 (58%) completed cognitive testing at each time-point respectively. NART IQ initially increased (mean difference (MD) = 1.32, 95% CI = 0.54 to 2.13, p < 0.001) before decreasing (MD = -4.269, 95% CI = -5.12 to -3.41, p < 0.001). ACE-R scores initially remained stable (MD = 0.29, 95% CI = -0.49 to 1.07, p > 0.05) before decreasing (MD = -1.05, 95% CI = -2.08 to -0.01, p < 0.05). Adjusting for baseline variables did not change the relationship between NART IQ and ACE-R with time. Increases in NART IQ were associated with more education. For ACE-R, older age was associated with declines, and higher NART IQ and more education was associated with increases. Across 3 years, we observed fluctuations in estimated premorbid IQ and minor changes in current cognitive ability. Future research should aim to identify variables associated with these changes. However, studies of post-stroke cognition should account for premorbid IQ.
在研究中风后的认知情况时，考虑病前或“峰值”成人智力（智商）很重要。病前智商估计值的稳定性及其与中风后当前认知能力的关系尚不清楚。我们调查了中风后长达三年的病前智商估计值和当前认知能力的变化。对轻度中风患者（美国国立卫生研究院卒中量表[NIHSS]<8）在中风后1至3个月、1年和3年进行评估。在每个时间点分别使用国家成人阅读测试（NART）和修订版的Addenbrooke认知检查（ACE-R）来估计病前智商（NART智商）和当前认知能力。纳入了基线人口统计学、血管和中风特征。在招募的264名患者（平均年龄66岁）中，分别有158名（60%）、151名（57%）和153名（5%）在每个时间点完成了认知测试。NART智商最初升高（平均差值[MD]=1.32，95%置信区间[CI]=0.54至2.13，p<0.001）随后下降（MD=-4.269，95%CI=-5.12至-3.41，p<0.001）。ACE-R评分最初保持稳定（MD=0.29，95%CI=-0.49至1.07，p>0.05）随后下降（MD=-1.05，95%CI=-2.08至-0.01，p<0.05）。对基线变量进行调整并没有改变NART智商和ACE-R与时间之间的关系。NART智商的升高与受教育程度更高有关。对于ACE-R，年龄较大与下降有关，而较高的NART智商和更多的教育与升高有关。在3年期间，我们观察到病前智商估计值存在波动，当前认知能力有微小变化。未来的研究应旨在确定与这些变化相关的变量。然而，中风后认知的研究应考虑病前智商。
