From the Brainnetome Center (F.Z.), Institute of Automation, Chinese Academy of Sciences, Beijing, China; Institute of Cognitive Neuroscience (F.Z.), University College London; Department of Epidemiology and Biostatistics (L.Y., Z.Y., W.X.), School of Public Health, Imperial College London, UK; Department of Geriatric Psychiatry (B.Z.), Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan; and Peking University Clinical Research Institute (W.X.), Peking University Health Science Center, Beijing, China.
Neurology. 2019 Jul 2;93(1):e20-e28. doi: 10.1212/WNL.0000000000007716. Epub 2019 May 24.
OBJECTIVE: To determine the trajectory of cognitive decline before and after incident stroke. METHODS: By using data from the English Longitudinal Study of Ageing, we studied 9,278 participants without dementia with no history of stroke who underwent cognitive assessment at baseline (wave 1) and at least 1 other time point (waves 2-7). We used linear mixed models to analyze repeated measures and longitudinal data. RESULTS: Among the 9,278 participants (56.8% women, mean age 63.1 ± 10.3 years), 471 (5.1%) incident stroke events were identified. Compared with stroke-free participants, multivariable-adjusted rates of prestroke cognitive decline in global cognition, memory, semantic fluency, and temporal orientation of participants who later experienced an incident stroke were increased by -0.029 , -0.016, -0.022, and -0.024 SD/y, respectively. Among the 471 stroke survivors, the multivariable-adjusted acute changes in the 4 cognitive domains were -0.257, -0.150, -0.121, and -0.272 SD, respectively. In the years after stroke, global cognition declined over time and was steeper than its prestroke slope, that is, by -0.064 SD/y after multivariable adjustment. The rates of memory, semantic fluency, and temporal orientation decline were -0.046, -0.033, and -0.037 SD/y, respectively. CONCLUSIONS: Accelerated prestroke cognitive decline and poststroke cognitive decline were associated with incident stroke over a follow-up period of 12 years. Attention should be paid to the long-term cognitive problems of stroke survivors, and intervention and management of major vascular risk factors should start from early life or midlife to reduce the risk of cerebrovascular disease and the associated cognitive impairment.
目的:确定发病前和发病后认知能力下降的轨迹。
方法:利用英国老龄化纵向研究的数据,我们研究了 9278 名无痴呆且无卒中病史的参与者,这些参与者在基线(第 1 波)和至少另外 1 个时间点(第 2-7 波)接受了认知评估。我们使用线性混合模型来分析重复测量和纵向数据。
结果:在 9278 名参与者中(56.8%为女性,平均年龄 63.1±10.3 岁),发现 471 例(5.1%)发病性卒中事件。与无卒中的参与者相比,后来发生卒中的参与者在整体认知、记忆、语义流畅性和时间定向方面的发病前认知衰退的多变量调整后率分别增加了-0.029、-0.016、-0.022 和-0.024 个标准差/年。在 471 名卒中幸存者中,4 个认知领域的多变量调整后的急性变化分别为-0.257、-0.150、-0.121 和-0.272 个标准差。在卒中后的几年中,整体认知随时间推移而下降,且下降幅度超过了发病前的斜率,即多变量调整后每年下降-0.064 个标准差。记忆、语义流畅性和时间定向的下降速度分别为-0.046、-0.033 和-0.037 个标准差/年。
结论:在 12 年的随访期间,加速的发病前认知衰退和发病后认知衰退与发病性卒中相关。应关注卒中幸存者的长期认知问题,并且应从中青年期开始关注主要血管风险因素的干预和管理,以降低脑血管疾病及其相关认知障碍的风险。
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