From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (A.M.H., A.E.L., W.M.v.d.F.), Amsterdam UMC, location VUmc, the Netherlands.
Department of Medical Humanities, Amsterdam Public Health Research Institute (A.M.H.), Amsterdam UMC, location VUmc, the Netherlands.
Stroke. 2019 Dec;50(12):3369-3375. doi: 10.1161/STROKEAHA.119.026031. Epub 2019 Nov 5.
Background and Purpose- Patients with cardiovascular disease are at increased risk for cognitive decline. We studied the occurrence and profile of cognitive impairment in 3 patient groups as exemplar conditions of hemodynamic disturbances at different levels of the heart-brain axis, including patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (possible vascular cognitive impairment [VCI]). Methods- In 555 participants (160 HF, 107 COD, 160 possible VCI, 128 reference participants; 68±9 years; 36% F; Mini-Mental State Examination 28±2), we assessed cognitive functioning with a comprehensive test battery. Test scores were transformed into -scores. Compound -scores were constructed for: memory, language, attention/psychomotor speed, executive functioning, and global cognitive functioning. We rated cognitive domains as impaired when -score≤-1.5. Based on the number of impaired domains, patients were classified as cognitively normal, minor, or major cognitive impairment. We used general linear models and χ tests to compare cognitive functioning between patient groups and the reference group. Results- Age, sex, and education adjusted global cognitive functioning z-score was lower in patients with COD (β [SE]=-0.46 [0.10], <0.001) and possible VCI (β [SE]=-0.80 [0.09], <0.001) compared with reference participants. On all domains, -scores were lower in patients with COD and possible VCI compared with reference participants. Patients with HF had lower z-scores on attention/speed and language compared with reference participants. Cognitive impairment was observed in 18% of HF, 36% of COD, and 45% possible VCI. There was no difference in profile of impaired cognitive domains between patient groups. Memory and attention-psychomotor speed were most commonly affected, followed by executive functioning and language. Conclusions- A substantial part of patients with HF and COD had cognitive impairment, which warrants vigilance for the occurrence of cognitive impairment. These results underline the importance of an integrative approach in medicine in patients presenting with disorders in the heart-brain axis.
背景与目的-心血管疾病患者认知能力下降的风险增加。我们研究了 3 组患者发生认知障碍的情况和特征，这 3 组患者分别代表了心脏-大脑轴不同水平的血流动力学障碍的典型情况，包括心力衰竭（HF）患者、颈动脉闭塞性疾病（COD）患者和磁共振成像上有认知主诉和血管性脑损伤的患者（可能的血管性认知障碍[VCI]）。方法-在 555 名参与者（160 名 HF、107 名 COD、160 名可能的 VCI、128 名参考参与者；68±9 岁；36%为女性；简易精神状态检查量表 28±2）中，我们使用全面的测试组合评估认知功能。将测试分数转换为 -分数。为记忆、语言、注意力/心理运动速度、执行功能和整体认知功能构建复合 -分数。当 -分数≤-1.5 时，我们将认知域评定为受损。根据受损域的数量，将患者分为认知正常、轻度或重度认知障碍。我们使用一般线性模型和 χ 检验比较患者组和参考组之间的认知功能。结果-在年龄、性别和教育程度调整后的整体认知功能 z 分数方面，COD 患者（β[SE]=-0.46[0.10]，<0.001）和可能的 VCI 患者（β[SE]=-0.80[0.09]，<0.001）低于参考参与者。在所有域中，COD 和可能的 VCI 患者的 -分数均低于参考参与者。HF 患者的注意力/速度和语言 z 分数低于参考参与者。HF 患者中有 18%、COD 患者中有 36%和可能的 VCI 患者中有 45%存在认知障碍。患者组之间认知障碍的模式没有差异。HF 患者的注意力/心理运动速度和语言方面的 z 分数较低。结论-相当一部分 HF 和 COD 患者存在认知障碍，这需要警惕认知障碍的发生。这些结果强调了在心脏-大脑轴出现障碍的患者中采用综合方法进行治疗的重要性。
