Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.
Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.
Stroke. 2021 Jun;52(6):2134-2142. doi: 10.1161/STROKEAHA.120.032258. Epub 2021 Apr 27.
Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status.
Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. We compared receipt of a composite quality measure representing the percentage of 7 treatments/procedures received (ordinal scale; values, <0.75, 0.75-0.99, and 1.0), a binary defect-free quality score, and individual treatments after AIS between patients with preexisting dementia (Informant Questionnaire on Cognitive Decline in the Elderly score ≥3.44), mild cognitive impairment (MCI, score 3.1-3.43), and normal cognition (score ≤3).
Among patients with AIS, 42% had normal cognition (47% women; median age [interquartile range], 65 [56-76]), 32% had MCI (54% women; median age, 70 [60-78]), 26% had dementia (56% women; median age, 78 [64-85]). After AIS, 44% of patients with preexisting dementia and 55% of patients with preexisting MCI or normal cognition received defect-free care. Compared with cognitively normal patients, patients with preexisting MCI had similar cumulative odds (unadjusted cumulative odds ratio =0.99, =0.92), and patients with preexisting dementia had 36% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio [OR]=0.64, =0.005). However, the dementia-quality association became nonsignificant after adjusting for patient factors, namely sex, comorbidity, and body mass index (adjusted cumulative OR [acOR]=0.79, =0.19). Independent of patient factors, preexisting MCI was negatively associated with receipt of IV tPA (intravenous tissue-type plasminogen activator; acOR=0.36, =0.04), rehabilitation assessment (acOR=0.28, =0.016), and echocardiogram (acOR=0.48, <0.001). Preexisting dementia was negatively associated with receipt of antithrombotic by day 2 (acOR=0.39, =0.04) and echocardiogram (acOR=0.42, <0.001).
Patients with preexisting MCI and dementia, compared with cognitively normal patients, may receive less frequently some treatments and procedures, but not the composite quality measure, after AIS.
认知状态对急性缺血性脑卒中（AIS）治疗的影响尚不清楚，但一些研究发现，患有痴呆症的患者接受的治疗较少。我们比较了不同认知状态下 AIS 的治疗情况。
对 2008 年至 2013 年期间，基于人群的科珀斯克里斯蒂脑卒中介入监测项目中 836 例年龄≥45 岁的 AIS 患者前瞻性获得的数据进行横断面分析。我们比较了存在痴呆（认知衰退简易量表得分≥3.44）、轻度认知障碍（MCI，得分 3.1-3.43）和认知正常（得分≤3）的患者接受 7 种治疗/操作（0.75-0.99、0.75-0.99 和 1.0 分）的复合质量测量、无缺陷质量评分和个体治疗的情况。
在 AIS 患者中，42%的患者认知正常（女性占 47%；中位年龄[四分位数范围]，65[56-76]岁），32%的患者有 MCI（女性占 54%；中位年龄，70[60-78]岁），26%的患者有痴呆（女性占 56%；中位年龄，78[64-85]岁）。AIS 后，44%的痴呆患者和 55%的 MCI 或认知正常患者接受了无缺陷治疗。与认知正常的患者相比，MCI 患者的累积优势比（未调整的累积优势比=0.99，=0.92）相似，而痴呆患者接受复合质量测量的累积优势比降低了 36%（未调整的累积优势比[OR]=0.64，=0.005）。然而，在调整了患者因素（性别、合并症和体重指数）后，痴呆与质量的关联变得无统计学意义（调整后的累积 OR[acOR]=0.79，=0.19）。独立于患者因素，MCI 与静脉注射组织型纤溶酶原激活剂（IV tPA；acOR=0.36，=0.04）、康复评估（acOR=0.28，=0.016）和超声心动图（acOR=0.48，<0.001）的使用率降低相关。痴呆与第 2 天抗血栓治疗（acOR=0.39，=0.04）和超声心动图（acOR=0.42，<0.001）的使用率降低相关。
与认知正常的患者相比，患有 MCI 和痴呆的患者在发生 AIS 后，一些治疗和操作的接受率可能较低，而非复合质量测量。
