Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
NHS Lothian, Edinburgh, UK.
Int J Stroke. 2022 Jul;17(6):618-627. doi: 10.1177/17474930211045836. Epub 2021 Sep 29.
Identifying whether acute stroke patients are at risk of cognitive decline could improve prognostic discussions and management. Structural computed tomography neuroimaging is routine in acute stroke, and may identify those at risk of post-stroke dementia or post-stroke cognitive impairment (PSCI).
To systematically review the literature to identify which stroke or pre-stroke features on brain computed tomography scans, performed at the time of stroke, are associated with post-stroke dementia or PSCI.
We searched electronic databases to December 2020. We included studies reporting acute stroke brain computed tomography, and later diagnosis of a cognitive syndrome. We created summary estimates of size of unadjusted association between computed tomography features and cognition. Of 9536 citations, 28 studies (41 papers) were eligible (N = 7078, mean age 59.8-78.6 years). Cognitive outcomes were post-stroke dementia (10 studies), PSCI (17 studies), and one study analyzed both. Fifteen studies (N = 2952) reported data suitable for meta-analyses. White matter lesions (WML) (six studies, N = 1054, OR = 2.46, 95% CI = 1.25-4.84), cerebral atrophy (four studies, N = 558, OR = 2.80, 95% CI = 1.21-6.51), and pre-existing stroke lesions (three studies, N = 352, OR = 2.38, 95% CI = 1.06-5.32) were associated with post-stroke dementia. WML (four studies, N = 473, OR = 3.46, 95% CI = 2.17-5.52) were associated with PSCI. Other computed tomography features were either not associated with cognitive outcome, or there were insufficient data.
Cognitive impairment following stroke is of great concern to patients and carers. Features seen on visual assessment of acute stroke computed tomography brain scans are strongly associated with cognitive outcomes. Clinicians should consider when and how this information should be discussed with stroke survivors.
识别急性脑卒中患者是否存在认知能力下降的风险，可以改善预后讨论和管理。结构性计算机断层神经影像学在急性脑卒中患者中是常规检查，并且可以识别出那些有卒中后痴呆或卒中后认知障碍（PSCI）风险的患者。
系统回顾文献，以确定在脑卒中时进行的脑计算机断层扫描（CT）上的哪些脑卒中或脑卒中前特征与脑卒中后痴呆或 PSCI 相关。
我们检索了截至 2020 年 12 月的电子数据库。我们纳入了报告急性脑卒中脑 CT 并随后诊断为认知综合征的研究。我们对 CT 特征与认知之间的未调整关联大小进行了汇总估计。在 9536 条引文中有 28 项研究（41 篇论文）符合条件（N=7078 例，平均年龄 59.8-78.6 岁）。认知结局为脑卒中后痴呆（10 项研究）、PSCI（17 项研究），一项研究同时分析了两者。15 项研究（N=2952）报告了适合进行荟萃分析的数据。脑白质病变（WML）（6 项研究，N=1054，OR=2.46，95%CI=1.25-4.84）、脑萎缩（4 项研究，N=558，OR=2.80，95%CI=1.21-6.51）和既往脑卒中病灶（3 项研究，N=352，OR=2.38，95%CI=1.06-5.32）与脑卒中后痴呆相关。WML（4 项研究，N=473，OR=3.46，95%CI=2.17-5.52）与 PSCI 相关。其他 CT 特征要么与认知结局无关，要么数据不足。
脑卒中后认知障碍是患者和照顾者非常关注的问题。急性脑卒中脑 CT 扫描的视觉评估所见的特征与认知结局密切相关。临床医生应考虑何时以及如何与脑卒中幸存者讨论这些信息。
