Li Juan, Wang Jing, Wu Bei, Xu Hanzhang, Wu Xiongfeng, Zhou Lanshu, Deng Benqiang
Naval Military Medical University School of Nursing, Shanghai, China.
Fudan University School of Nursing, Shanghai, China.
Front Neurol. 2020 Feb 26;11:20. doi: 10.3389/fneur.2020.00020. eCollection 2020.
Cognitive decline is common after stroke. The influence of early cognitive impairment on midterm functional outcomes among Chinese acute ischemic stroke (AIS) patients has not been fully studied. The aim of the study was to assess the association between early cognitive impairment and midterm functional outcomes among Chinese AIS patients. A longitudinal survey focusing on Chinese AIS patients was conducted in three stroke centers in Shanghai, China (July to December 2016). A total of 185 eligible patients were interviewed at acute stage and at 1, 3, and 6 months after onset. Patients' functional outcomes were measured by modified Rankin Scale (mRS) and Barthel Index (BI) at each time point. Cognitive function was assessed using Montreal Cognitive Assessment, Changsha version (MoCA-CS), within 7 days after stroke onset. Covariates included patient's demographic characteristics, socioeconomic status, clinical characteristics of stroke, vascular risk factors, receiving rehabilitation after discharge from acute hospital, and recurrence. Generalized linear mixed models and general linear mixed models were applied. The prevalence of cognitive impairment at acute stage of stroke among these patients was 88.1%. The risk of disability (mRS 2-5) of all patients after stroke decreased over time (OR = 0.491, 95% CI = 0.401-0.603). The risk of disability among those with cognitive impairment increased compared with those with normal cognition (OR = 7.384, 95% CI = 1.041-52.407). The BI score of all patients increased over time after controlling for covariates (β = 1.51, < 0.01). The BI score of those with cognitive impairment was lower than that with normal cognition over the follow-up period after controlling for other covariates (β = -8.11, < 0.05). This study showed that early cognitive impairment was associated with higher risk of disability and poor activity of daily living (ADL) among Chinese AIS patients. Further studies are needed to examine the linkage between multi-domain cognitive impairment and long-term disability and ADL among stroke survivors by using neuropsychological test batteries.
认知功能下降在卒中后很常见。早期认知障碍对中国急性缺血性卒中（AIS）患者中期功能结局的影响尚未得到充分研究。本研究的目的是评估中国AIS患者早期认知障碍与中期功能结局之间的关联。2016年7月至12月在中国上海的三个卒中中心对中国AIS患者进行了一项纵向调查。共有185例符合条件的患者在急性期以及发病后1个月、3个月和6个月接受了访谈。在每个时间点使用改良Rankin量表（mRS）和Barthel指数（BI）测量患者的功能结局。在卒中发病后7天内使用长沙版蒙特利尔认知评估量表（MoCA-CS）评估认知功能。协变量包括患者的人口统计学特征、社会经济状况、卒中的临床特征、血管危险因素、急性医院出院后接受康复治疗情况以及复发情况。应用广义线性混合模型和一般线性混合模型。这些患者卒中急性期认知障碍的患病率为88.1%。卒中后所有患者的残疾风险（mRS 2 - 5）随时间下降（OR = 0.491，95%CI = 0.401 - 0.603）。与认知正常者相比，认知障碍者的残疾风险增加（OR = 7.384，95%CI = 1.041 - 52.407）。在控制协变量后，所有患者的BI评分随时间增加（β = 1.51，P < 0.01）。在控制其他协变量后的随访期内，认知障碍者的BI评分低于认知正常者（β = -8.11，P < 0.05）。本研究表明，早期认知障碍与中国AIS患者更高的残疾风险和较差的日常生活活动能力（ADL）相关。需要进一步研究通过使用神经心理测试组合来检查多领域认知障碍与卒中幸存者长期残疾和ADL之间的联系。
