Gong Jessica, Harris Katie, Tzourio Christophe, Harrap Stephen, Naismith Sharon, Anderson Craig S, Chalmers John, Woodward Mark
George Institute for Global Health, University of New South Wales, Sydney, Australia.
Bordeaux Population Health Research Center, Bordeaux University, INSERM, Bordeaux, France.
Int J Stroke. 2021 Nov 18:17474930211059298. doi: 10.1177/17474930211059298.
Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia.
We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk.
Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs).
Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63-0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72-0.98), with no evidence of sex difference. Higher education (0.96,0.94-0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82-0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02-1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m (1.27,1.03-1.58), and peripheral arterial disease (1.78,1.26-2.52) were associated with higher odds of cognitive decline/dementia. was not associated with cognitive decline/dementia (1.05 (0.85-1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03-2.48)). Diabetes was more strongly associated with men than women.
Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia. This trial was not registered because enrolment began before 1 July 2005.
中风和短暂性脑缺血发作会增加认知功能下降和痴呆的风险。
我们使用培哚普利预防复发性中风研究（PROGRESS）的数据，这是一项针对中风/短暂性脑缺血发作患者的降压随机对照试验。我们评估了认知功能下降/痴呆治疗效果的总体差异和性别差异，以及与血管和中风特异性预测因素的关联，并将死亡视为竞争风险。
采用多项逻辑回归来估计与认知功能下降/痴呆风险相关的治疗效果和预测因素的总体及性别特异性优势比（OR）（95%置信区间（CI）），以及优势比的女性与男性比值（RORs）。
在中位时间为四年的研究中，5888名参与者中有763例出现认知功能下降/痴呆（女性占30.9%）。女性出现认知功能下降/痴呆的几率低于男性（OR 0.78，95%CI 0.63 - 0.95）。积极治疗与认知功能下降/痴呆几率较低相关（0.84，0.72 - 0.98），且无性别差异证据。高等教育程度（0.96，0.94 - 0.98（每年））和基线简易精神状态检查表（MMSE）得分较高与认知功能下降/痴呆几率较低相关（0.84，0.82 - 0.86（每提高一分））。较高的舒张压（1.11，1.02 - 1.20（每10 mmHg））、估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²（1.27，1.03 - 1.58）和外周动脉疾病（1.78，1.26 - 2.52）与认知功能下降/痴呆几率较高相关。[此处原文缺失一项内容]与认知功能下降/痴呆无关（1.05（0.85 - 1.30））。低eGFR与女性认知功能下降/痴呆的关联比男性更强（RORs，1.60（1.03 - 2.48））。糖尿病与男性的关联比女性更强。
既往有中风/短暂性脑缺血发作的人群中，多种风险因素与认知功能下降/痴呆相关，且存在显著的性别差异。应考虑中风的长期认知后遗症，以加强针对中风、认知功能下降和痴呆的联合预防策略。该试验未进行注册，因为入组于2005年7月1日前开始。
