Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine (R.P.S., E.C., S.L.D., P.S., D.W.).
Department of Neurology, University of Michigan Health System, Ann Arbor (E.Y.).
Stroke. 2021 Jan;52(2):603-610. doi: 10.1161/STROKEAHA.120.030084. Epub 2021 Jan 20.
In intracerebral hemorrhage (ICH), preexisting cognitive impairment has been identified as a risk factor for increased mortality and morbidity. However, previous studies examined predominantly White populations; therefore, the prevalence and effect of preICH cognitive impairment has not been studied in a multiethnic cohort. This limits the generalizability of previous findings. We sought to investigate the role of preexisting cognitive impairment in a multiethnic population on short-term mortality and functional outcomes after ICH.
Patients with ICH were prospectively enrolled as cases for the GERFHS III (Genetic and Environmental Risk Factors for Hemorrhagic Stroke) Study and the Ethnic/Racial Variations of ICH (ERICH) Study. Cognitive impairment before ICH was defined as positive history of dementia or treatment with donepezil, galantamine, memantine, or rivastigmine on chart abstraction or baseline interview. Specific outcomes-modified Rankin Scale score at 3 months (0-2 versus ≥3), Barthel Index score (<100 versus 100) at 3 months, and withdrawal of care-were analyzed using multivariable logistic regression. Propensity score matching and analysis was done because of imbalances between cognitively impaired and cognitively intact groups.
Of the 3537 cases of ICH, 304 patients had cognitive impairment predating ICH. Cognitively impaired subjects were more likely to experience withdrawal of care during hospitalization, and for survivors, greater disability (modified Rankin Scale score of ≥3) and lower Barthel scores after ICH. After propensity score matching, preexisting cognitive impairment was associated with a lower modified Rankin Scale at 3 months in the White, Black, and Hispanic subgroups.
Preexisting cognitive impairment was associated with loss of independence 3-month post-ICH, when matching for risk factors of cognitive impairment, in the White, Black, and Hispanic subgroups. This suggests that preexisting cognitive impairment has a negative effect in obtaining functional independence following ICH, irrespective of race/ethnicity.
在脑出血（ICH）中，先前存在的认知障碍已被确定为增加死亡率和发病率的危险因素。然而，之前的研究主要检查了白种人群；因此，ICH 前认知障碍的流行率和影响尚未在多民族队列中进行研究。这限制了先前研究结果的普遍性。我们旨在调查在多民族人群中，预先存在的认知障碍在 ICH 后短期死亡率和功能结局中的作用。
ICH 患者前瞻性纳入 GERFHS III（出血性中风的遗传和环境风险因素）研究和 ERICH（ICH 的种族/种族差异）研究作为病例。ICH 前认知障碍的定义为在病历摘录或基线访谈中，有痴呆病史或正在接受多奈哌齐、加兰他敏、美金刚或利伐斯的治疗。使用多变量逻辑回归分析特定结局（3 个月时改良 Rankin 量表评分[0-2 与≥3]、3 个月时 Barthel 指数评分[<100 与 100]、放弃治疗）。由于认知障碍组和认知正常组之间存在不平衡，因此进行了倾向评分匹配和分析。
在 3537 例 ICH 病例中，有 304 例患者在 ICH 前存在认知障碍。认知障碍患者在住院期间更有可能放弃治疗，对于幸存者，ICH 后残疾程度更高（改良 Rankin 量表评分≥3）且 Barthel 评分更低。在进行倾向评分匹配后，在白种人、黑人和西班牙裔亚组中，预先存在的认知障碍与 3 个月时较低的改良 Rankin 量表评分相关。
在匹配认知障碍的危险因素后，预先存在的认知障碍与 ICH 后 3 个月丧失独立性相关，在白种人、黑人和西班牙裔亚组中均如此。这表明，预先存在的认知障碍对获得 ICH 后功能独立性有负面影响，而与种族/族裔无关。
