Department of Neurology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
J Neurol. 2019 Oct;266(10):2495-2504. doi: 10.1007/s00415-019-09442-6. Epub 2019 Jun 28.
Although post-stroke cognitive deficit can significantly limit patient independence and social re-integration, clinical routine predictors for this condition are lacking. 'Cognitive reserve' limits the detrimental effects of slowly developing neurodegeneration. We aimed to determine whether comparable effects also exist in acute stroke. Using 'years of education' as a proxy, we investigated whether cognitive reserve beneficially influences cognitive performance and disability after stroke, whilst controlling for age and lesion size as measure of stroke pathology.
Within the first week of ischemic right hemisphere stroke, 36 patients were assessed for alertness, working memory, executive functions, spatial neglect, global cognition and motor deficit at 4.9 ± 2.1 days post-stroke, in addition to routine clinical tests (NIH Stroke Scale, modified Rankin Scale on admission < 24 h post-stroke and at discharge 9.5 ± 4.7 days post-stroke). The impact of education was assessed using partial correlation analysis adjusted for lesion size, age, and the time interval between stroke and assessment. To validate our results, we compared groups with similar age and lesion load, but different education levels.
In the acute stroke phase, years of education predicted both severity of education independent (alertness) and education dependent (working memory, executive functions, global cognition) cognitive deficits and disability (modified Rankin Scale). Spatial neglect seemed to be independent.
Proxies of cognitive reserve should be considered in stroke research as early as in the acute stroke phase. Cognitive reserve contributes to inter-individual variability in the initial severity of cognitive deficits and disability in acute stroke, and may suggest individualised rehabilitation strategies.
尽管中风后认知功能缺损会显著限制患者的独立性和社会再融入，但目前缺乏针对这种情况的临床常规预测指标。“认知储备”限制了缓慢发生的神经退行性变的有害影响。我们旨在确定类似的影响是否也存在于急性中风中。我们使用“受教育年限”作为替代指标，研究认知储备是否会对中风后的认知表现和残疾产生有益影响，同时控制年龄和病灶大小作为中风病理的衡量标准。
在缺血性右侧半球中风后的第一周内，36 名患者在中风后 4.9±2.1 天接受警觉、工作记忆、执行功能、空间忽略、整体认知和运动缺陷评估，此外还进行了常规临床测试（NIH 中风量表、中风后 24 小时内入院时和 9.5±4.7 天出院时的改良 Rankin 量表）。使用偏相关分析，根据病灶大小、年龄以及中风和评估之间的时间间隔，评估教育的影响。为了验证我们的结果，我们比较了年龄和病灶负荷相似但受教育程度不同的组。
在急性中风阶段，受教育年限不仅预测了教育独立（警觉）和教育依赖（工作记忆、执行功能、整体认知）认知缺陷和残疾（改良 Rankin 量表）的严重程度，而且预测了空间忽略的严重程度。
在急性中风阶段，认知储备的替代指标应尽早考虑纳入中风研究。认知储备有助于解释急性中风中个体认知缺陷和残疾严重程度的个体差异，并可能提示个体化的康复策略。
