From the Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, France.
Stroke. 2020 Jun;51(6):1667-1673. doi: 10.1161/STROKEAHA.119.028845. Epub 2020 May 13.
Background and Purpose- The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. Methods- Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013-2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. Results- Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS: 6; interquartile range, 2-15), and those with dementia (n=164; median NIHSS: 7; interquartile range, 3-16), than in patients without cognitive impairment (n=752; median NIHSS: 3; interquartile range, 1-9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21-2.38]; =0.002) and dementia (OR, 2.24 [95% CI, 1.65-3.04]; <0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02-2.28]; =0.04 for MCI; OR, 2.16 [95% CI, 1.45-3.22]; <0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98-2.25]; =0.06 for MCI, and OR, 1.98 [95% CI, 1.26-3.12]; =0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function. Conclusions- Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.
背景与目的- 目前人口老龄化与越来越多的存在认知障碍的卒中患者相关。本研究旨在根据卒中前认知状态评估缺血性卒中患者的临床严重程度。
方法- 使用人群登记处（2013-2017 年）前瞻性识别法国第戎的缺血性卒中患者。记录卒中前认知状态（无认知障碍、轻度认知障碍[MCI]或痴呆），并使用国立卫生研究院卒中量表（NIHSS）评分评估卒中发病时的严重程度。使用有序回归分析模型评估卒中前认知状态与严重程度之间的关系，其中 NIHSS 评分被视为分类变量。
结果- 在 1048 名患者（平均年龄 76.3±15.2 岁，54.0%为女性）中，MCI（n=132；NIHSS 中位数：6，四分位距：2-15）和痴呆（n=164；NIHSS 中位数：7，四分位距：3-16）患者的严重程度高于无认知障碍患者（n=752；NIHSS 中位数：3，四分位距：1-9）。MCI（比值比[OR]，1.70[95%置信区间，1.21-2.38]；=0.002）和痴呆（OR，2.24[95%置信区间，1.65-3.04]；<0.001）均与发病时的严重程度增加相关。在校正临床变量和近端动脉闭塞后，这种关联仍然存在（MCI：OR，1.52[95%置信区间，1.02-2.28]；=0.04；痴呆：OR，2.16[95%置信区间，1.45-3.22]；<0.001）。进一步校正卒中前残障程度略微降低了关联的幅度（MCI：OR，1.49[95%置信区间，0.98-2.25]；=0.06；痴呆：OR，1.98[95%置信区间，1.26-3.12]；=0.02）。存在卒中前认知障碍的患者的严重程度增加并非特定于运动或语言功能的更严重损害。
结论- 存在认知障碍的患者发生更严重的缺血性卒中。这一结果可能反映了急性缺血对大脑的耐受性较低。需要进一步研究以探讨可能从神经保护治疗角度靶向的潜在机制。
