Department of Neurology, Danish Stroke Centre, Aarhus University Hospital, Skejby, Denmark,
Department of Neurology, Danish Stroke Centre, Aarhus University Hospital, Skejby, Denmark.
Cerebrovasc Dis. 2020;49(6):632-638. doi: 10.1159/000511490. Epub 2020 Nov 11.
Physical activity (PA) is associated with a lower risk of stroke and stroke mortality as well as a favorable stroke outcome. PA may also prevent general cognitive decline. Poststroke cognitive impairment is both common and disabling, and focusing on all possible preventive measures is important. Studies on the effect of PA on poststroke cognitive performance are sparse, however. We therefore aimed to examine the association between prestroke PA and poststroke cognitive performance.
We studied the correlation between prestroke PA and poststroke cognitive performance in a prespecified analysis in The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial. We used the Physical Activity Scale for the Elderly (PASE) to collect information on PA during the 7-day period before stroke. PA was quantified, and patients were stratified into quartiles based on their PASE score. Cognitive performance was measured using the Symbol Digit Modalities Test (SDMT) at 1 and 6 months and the Mini-Mental State Examination (MMSE) at 6 months. The functional outcome was assessed using the modified Rankin Scale (mRS).
In total, 625 of 642 patients (97%) completed the PASE questionnaire. The median age was 69 (interquartile range [IQR]: 60-77), and the median PASE score was 137 (82-205). Higher prestroke PASE quartiles (2nd, 3rd, and 4th, each compared to the 1st) were independently associated with a higher SDMT score at 1 month in the both the univariable and multivariable analyses (2nd: 3.99 points, 95% confidence interval [CI]: 1.01-6.97; 3rd: 3.6, CI: 0.6-6.61; 4th: 4.1, CI: 0.95-7.24). This association remained at 6 months. PA was not statistically associated with the MMSE score or mRS.
Higher prestroke PA was associated with a better cognitive performance as measured by the SDMT at 1 and 6 months poststroke. We found no significant association between prestroke PA and functional outcome. Our results are encouraging and support further investigations of PA as a protective measure against poststroke cognitive impairment.
身体活动（PA）与较低的中风风险和中风死亡率以及较好的中风预后相关。PA 也可能预防一般认知能力下降。中风后认知障碍既常见又致残，关注所有可能的预防措施非常重要。然而，关于 PA 对中风后认知表现影响的研究很少。因此，我们旨在研究中风前 PA 与中风后认知表现之间的关系。
我们在急性缺血性中风的西酞普兰治疗效果（TALOS）试验的预先指定分析中研究了中风前 PA 与中风后认知表现之间的相关性。我们使用老年人身体活动量表（PASE）在中风前的 7 天内收集 PA 信息。PA 进行量化，并根据 PASE 评分将患者分为四组。认知表现使用符号数字模态测试（SDMT）在 1 个月和 6 个月时以及在 6 个月时使用简易精神状态检查（MMSE）进行测量。功能结局使用改良 Rankin 量表（mRS）进行评估。
在总共 642 名患者中，有 625 名（97%）完成了 PASE 问卷。中位年龄为 69 岁（四分位间距 [IQR]：60-77 岁），中位 PASE 评分为 137（82-205）。在单变量和多变量分析中，较高的中风前 PASE 四分位组（第 2、3 和 4 组，每组与第 1 组相比）与 1 个月时的 SDMT 评分较高独立相关（第 2 组：3.99 分，95%置信区间 [CI]：1.01-6.97；第 3 组：3.6，CI：0.6-6.61；第 4 组：4.1，CI：0.95-7.24）。这种关联在 6 个月时仍然存在。PA 与 MMSE 评分或 mRS 无统计学关联。
中风前 PA 较高与中风后 1 个月和 6 个月时的 SDMT 测量的认知表现较好相关。我们未发现中风前 PA 与功能结局之间存在显著关联。我们的结果令人鼓舞，支持进一步研究 PA 作为预防中风后认知障碍的保护措施。
