Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopaedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Front Public Health. 2021 May 19;9:637042. doi: 10.3389/fpubh.2021.637042. eCollection 2021.
The aim of this study was to explore the longitudinal associations of stroke with cognitive impairment in older US adults. The data used in this longitudinal analysis were extracted from the National Health and Aging Trends Study (NHATS) from 2011 to 2019. Univariate and multivariable Cox proportional hazards regression models were used to estimate the longitudinal association of stroke with cognitive impairment. The multivariable model was adjusted by demographic, physical, and mental characteristics, and the complex survey design of NHATS was taken into consideration. A total of 7,052 participants with complete data were included. At the baseline, the weighted proportion of cognitive impairment was 19.37% (95% CI, 17.92-20.81%), and the weighted proportion of the history of stroke was 9.81% (95% CI, 8.90-10.72%). In univariate analysis, baseline stroke history was significantly associated with cognitive impairment in the future (hazard ratio, 1.746; 95% CI, 1.461-2.088), and the baseline cognitive impairment was significantly associated with future report of stroke (hazard ratio, 1.436; 95% CI, 1.088-1.896). In multivariable model, stroke was also significantly associated with cognitive impairment (hazard ratio, 1.241; 95% CI, 1.011-1.522); however, the reverse association was not significant (hazard ratio, 1.068; 95% CI, 0.788-1.447). After the data from proxy respondents were excluded, in the sensitive analyses, the results remained unchanged. Older adults in the United States who suffered strokes are more likely to develop cognitive impairment as a result in the future than those who have not had strokes. However, the reverse association did not hold. Furthermore, the study suggests that it is necessary to screen and take early intervention for cognitive impairment in stroke survivors and prevent the incidence of stroke by modifying risk factors in the general population with rapidly growing older US adults.
本研究旨在探讨老年美国人群中卒中与认知障碍的纵向关联。本纵向分析使用的数据来自 2011 年至 2019 年的国家健康老龄化趋势研究（NHATS）。采用单变量和多变量 Cox 比例风险回归模型来估计卒中与认知障碍的纵向关联。多变量模型调整了人口统计学、身体和精神特征，并考虑了 NHATS 的复杂调查设计。共纳入 7052 名数据完整的参与者。基线时，认知障碍的加权比例为 19.37%（95%CI，17.92-20.81%），卒中病史的加权比例为 9.81%（95%CI，8.90-10.72%）。在单变量分析中，基线卒中史与未来认知障碍显著相关（风险比，1.746；95%CI，1.461-2.088），基线认知障碍与未来卒中报告显著相关（风险比，1.436；95%CI，1.088-1.896）。在多变量模型中，卒中与认知障碍也显著相关（风险比，1.241；95%CI，1.011-1.522）；然而，反向关联不显著（风险比，1.068；95%CI，0.788-1.447）。排除代理受访者的数据后，在敏感性分析中，结果保持不变。与没有卒中的老年人相比，美国老年卒中患者未来更有可能发生认知障碍。然而，反向关联并不成立。此外，该研究表明，有必要对卒中幸存者进行认知障碍筛查和早期干预，并通过改变快速增长的老年美国人群中的危险因素来预防卒中的发生。
