Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan,
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Cerebrovasc Dis. 2021;50(4):390-396. doi: 10.1159/000514368. Epub 2021 Mar 19.
Pre-stroke dementia is significantly associated with poor stroke outcome. Cholinesterase inhibitors (ChEIs) might reduce the risk of stroke in patients with dementia. However, the association between pre-stroke ChEI treatment and stroke outcome remains unresolved. Therefore, we aimed to determine this association in patients with acute ischemic stroke and pre-stroke dementia.
We enrolled 805 patients with pre-stroke dementia among 13,167 with ischemic stroke within 7 days of onset who were registered in the Fukuoka Stroke Registry between June 2007 and May 2019 and were independent in basic activities of daily living (ADLs) before admission. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale [mRS] score: 3-6) at 3 months after stroke onset and neurological deterioration (≥2-point increase in the NIH Stroke Scale [NIHSS] during hospitalization), respectively. Logistic regression analysis was used to evaluate associations between pre-stroke ChEI treatment and study outcomes. To improve covariate imbalance, we further conducted a propensity score (PS)-matched cohort study.
Among the participants, 212 (26.3%) had pre-stroke ChEI treatment. Treatment was negatively associated with poor functional outcome (odds ratio: 0.68 [95% confidence interval: 0.46-0.99]) and neurological deterioration (0.52 [0.31-0.88]) after adjusting for potential confounding factors. In the PS-matched cohort study, the same trends were observed between pre-stroke ChEI treatment and poor functional outcome (0.61 [0.40-0.92]) and between the treatment and neurological deterioration (0.47 [0.25-0.86]).
Our findings suggest that pre-stroke ChEI treatment is associated with reduced risks for poor functional outcome and neurological deterioration after acute ischemic stroke in patients with pre-stroke dementia who are independent in basic ADLs before the onset of stroke.
卒中前痴呆与较差的卒中结局显著相关。胆碱酯酶抑制剂（ChEIs）可能降低痴呆患者发生卒中的风险。然而，卒中前使用 ChEI 治疗与卒中结局之间的关联仍未解决。因此，我们旨在确定急性缺血性卒中合并卒中前痴呆患者中存在这种关联。
我们纳入了 2007 年 6 月至 2019 年 5 月期间在福冈卒中登记处登记的 13167 例发病 7 天内的缺血性卒中患者中的 805 例卒中前痴呆患者，这些患者在入院前日常生活活动（ADLs）基本自理。主要和次要研究结局分别为卒中发病后 3 个月时的不良功能结局（改良 Rankin 量表[ mRS ]评分：3-6 分）和住院期间神经功能恶化（NIH 卒中量表[NIHSS]评分增加≥2 分）。采用 logistic 回归分析评估卒中前 ChEI 治疗与研究结局之间的关系。为了改善协变量的不平衡，我们进一步进行了倾向评分（PS）匹配队列研究。
在参与者中，有 212 例（26.3%）卒中前使用 ChEI 治疗。在校正潜在混杂因素后，治疗与不良功能结局（比值比：0.68 [95%置信区间：0.46-0.99]）和神经功能恶化（0.52 [0.31-0.88]）呈负相关。在 PS 匹配的队列研究中，卒中前 ChEI 治疗与不良功能结局（0.61 [0.40-0.92]）和治疗与神经功能恶化（0.47 [0.25-0.86]）之间也观察到相同的趋势。
我们的研究结果表明，在卒中前日常生活活动基本自理的缺血性卒中合并卒中前痴呆患者中，卒中前使用 ChEI 治疗与急性缺血性卒中后不良功能结局和神经功能恶化风险降低相关。
