Johnen A, Räthe S, Lohmann H, Philipp K, Minnerup J, Wiendl H, Meuth S G, Duning T
Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
Nervenarzt. 2020 Feb;91(2):131-140. doi: 10.1007/s00115-019-00830-x.
Longitudinal studies on cognitive outcomes after stroke revealed heterogeneous results and the underlying pathology and risk factors for so-called post-stroke dementia are unclear.
To assess long-term cognitive performance changes in patients after the first ischemic stroke and to evaluate possible risk factors for post-stroke dementia.
In this study 66 clinically mildly affected patients aged 54-87 years without a history of dementia underwent extensive neuropsychological assessment after first ever ischemic stroke and again 6 months after the event (follow-up assessment). Demographic, clinical and paraclinical parameters were assessed as potential predictors for long-term cognitive outcome.
At the group level significant performance improvements were found for most of the neurocognitive domains at the follow-up assessment. The greatest cognitive improvement was found in visuospatial processing. Immediately after stroke 54.5% of patients were considered cognitively impaired (z-scores < -2 in at least 2 neurocognitive domains). At follow-up only 16.7% were considered cognitively impaired according to this criterion and among these only 2 patients (3%) had developed a new, clinically relevant cognitive impairment (i.e. post-stroke dementia). Patients with inferior cognitive performance improvements at follow-up had on average larger brain lesions caused by the stroke as well as a prediabetic metabolic status.
The probability of developing a post-stroke dementia syndrome is lower than previously assumed in patients with first ever stroke, with only mild clinical disability and without premorbid cognitive impairment. Long-term cognitive impairment could primarily be determined by the size of the lesioned brain area as well as the premorbid (pre)diabetic status.
关于中风后认知结果的纵向研究结果不一，所谓中风后痴呆的潜在病理和风险因素尚不清楚。
评估首次缺血性中风患者的长期认知功能变化，并评估中风后痴呆的可能风险因素。
本研究中，66名年龄在54 - 87岁、无痴呆病史且临床症状轻微的患者在首次缺血性中风后接受了广泛的神经心理学评估，并在事件发生6个月后再次进行评估（随访评估）。评估人口统计学、临床和辅助临床参数作为长期认知结果的潜在预测因素。
在随访评估中，在组水平上发现大多数神经认知领域有显著的功能改善。在视觉空间处理方面发现了最大的认知改善。中风后立即有54.5%的患者被认为存在认知障碍（至少2个神经认知领域的z分数＜ -2）。根据该标准，随访时只有16.7%的患者被认为存在认知障碍，其中只有2名患者（3%）出现了新的、具有临床相关性的认知障碍（即中风后痴呆）。随访时认知功能改善较差的患者平均中风引起的脑损伤更大，且有糖尿病前期代谢状态。
首次中风、临床残疾轻微且无病前认知障碍的患者发生中风后痴呆综合征的概率低于先前假设。长期认知障碍可能主要由脑损伤区域的大小以及病前糖尿病状态决定。
