Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France.
Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France,
Neuroepidemiology. 2020;54(6):490-497. doi: 10.1159/000497614. Epub 2019 Oct 8.
We assessed the association between pre-stroke cognitive status and 90-day case-fatality.
Patients with ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH) were prospectively identified among residents of Dijon, France, between 2013 and 2015, using a population-based registry. Association between pre-stroke cognitive status and case-fatality at 90 days was evaluated using Cox regression.
Seven hundred sixty-two patients were identified, and information about pre-stroke cognitive status was obtained for 716 (92.6%) of them, including 603 IS (84.2%) and 113 ICH (15.8%). Before stroke, 99 (13.8%) patients had mild cognitive impairment (MCI) and 98 (13.7%) had dementia. Patients with cognitive impairment were older, had a higher prevalence of several risk factors, more severe stroke, more frequent ICH, and less admission to stroke unit. Case-fatality rate at 90 days was 11.7% in patients without cognitive impairment, 32.3% in MCI patients, and 55.1% in patients with dementia. In multivariable analyses, pre-existing MCI (hazard ratio [HR] 2.22, 95% CI 1.21-4.05, p = 0.009) and dementia (HR 4.35, 95% CI 2.49-7.61, p < 0.001) were both associated with 90-day case-fatality.
Pre-stroke MCI and dementia were both associated with increased mortality. These associations were not fully explained by baseline characteristics, pre-stroke dependency, stroke severity or patient management, and underlying reasons need to be investigated.
评估卒中前认知状态与 90 天病死率的关系。
2013 年至 2015 年期间，采用基于人群的登记系统，前瞻性地在法国第戎的居民中识别缺血性卒中（IS）或自发性脑出血（ICH）患者。使用 Cox 回归评估卒中前认知状态与 90 天病死率之间的关系。
共确定了 762 例患者，其中 716 例（92.6%）获得了卒中前认知状态的信息，包括 603 例 IS（84.2%）和 113 例 ICH（15.8%）。卒中前，99 例（13.8%）患者有轻度认知障碍（MCI），98 例（13.7%）有痴呆。认知障碍患者年龄较大，多种危险因素的患病率较高，卒中较严重，ICH 更常见，卒中单元入院治疗的比例较低。无认知障碍患者的 90 天病死率为 11.7%，MCI 患者为 32.3%，痴呆患者为 55.1%。多变量分析显示，预先存在的 MCI（HR 2.22，95%CI 1.21-4.05，p = 0.009）和痴呆（HR 4.35，95%CI 2.49-7.61，p < 0.001）均与 90 天病死率相关。
卒中前 MCI 和痴呆均与死亡率增加相关。这些关联不能完全用基线特征、卒中前依赖、卒中严重程度或患者管理来解释，需要进一步调查其根本原因。
