Pendlebury Sarah T, Thomson Ross J, Welch Sarah J V, Rothwell Peter M
Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Cerebrovasc Dis. 2022;51(3):288-295. doi: 10.1159/000519900. Epub 2021 Nov 29.
TIA and stroke cause cognitive impairment with a typical "vascular" pattern, including prominent frontal/executive deficits. Cognitive impairment is associated with increased delirium risk and the few available data suggest that executive dysfunction is important. We therefore determined the predictive value of both severity and pattern of cognitive deficits for delirium on long-term follow-up after TIA/stroke.
Surviving TIA/stroke participants on October 1, 2013, in the Oxford Vascular Study (OXVASC) were assessed prospectively for delirium during all hospitalizations over the subsequent 6 months. Associations between OXVASC pre-admission mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores, and delirium during hospitalizations on follow-up were determined using logistic regression adjusted for covariates, including demographic factors, history of depression, baseline stroke severity, and admission illness severity.
Among 1,565 TIA/stroke survivors, 158 patients (mean/SD age = 79.2/11.5 years) had ≥1 admission and 59 (37%) had ≥1 delirium episode. Mean/SD time between baseline TIA/stroke and admission was 4.7/3.6 years and between most recent OXVASC cognitive testing and admission was 1.7/1.8 years. MMSE and MoCA scores were associated with delirium: odds ratio (OR) = 1.16 (95% CI 1.07-1.27, p < 0.0001 per point decrease in MMSE) and OR = 1.20 (1.11-1.30, p < 0.0001 MoCA) and associations were robust to adjustment for all covariates, including stroke severity: OR = 1.11 (1.01-1.22, p = 0.03, MMSE) and OR = 1.15 (1.05-1.25, p = 0.003, MoCA). All 10 subtests on the MoCA and 4/11 on the MMSE were significantly associated with delirium with highest predictive value for frontal/executive and recall domains.
Cognitive impairment of increasing severity after TIA/stroke predisposed to delirium particularly deficits in frontal/executive domains and recall. Long-term risk of delirium should be considered as part of the overall cerebrovascular disease burden.
短暂性脑缺血发作（TIA）和中风会导致具有典型“血管性”模式的认知障碍，包括明显的额叶/执行功能缺陷。认知障碍与谵妄风险增加相关，而现有的少量数据表明执行功能障碍很重要。因此，我们确定了TIA/中风后长期随访时谵妄的认知缺陷严重程度和模式的预测价值。
在牛津血管研究（OXVASC）中，对2013年10月1日存活的TIA/中风参与者在随后6个月的所有住院期间进行谵妄的前瞻性评估。使用针对协变量（包括人口统计学因素、抑郁症病史、基线中风严重程度和入院疾病严重程度）进行调整的逻辑回归，确定OXVASC入院前简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评分与随访期间住院期间谵妄之间的关联。
在1565名TIA/中风幸存者中，158名患者（平均/标准差年龄 = 79.2/11.5岁）有≥1次入院，59名（37%）有≥1次谵妄发作。基线TIA/中风与入院之间的平均/标准差时间为4.7/3.6年，最近一次OXVASC认知测试与入院之间的时间为1.7/1.8年。MMSE和MoCA评分与谵妄相关：优势比（OR） = 1.16（95%可信区间1.07 - 1.27，MMSE每降低1分，p < 0.0001）和OR = 1.20（1.11 - 1.30，MoCA，p < 0.0001），并且在对所有协变量（包括中风严重程度）进行调整后，关联仍然稳健：OR = 1.11（1.01 - 1.22，p = 0.03，MMSE）和OR = 1.15（1.05 - 1.25，p = 0.003，MoCA）。MoCA上的所有10个分测验和MMSE上的4/11个分测验与谵妄显著相关，对额叶/执行功能和回忆领域的预测价值最高。
TIA/中风后严重程度不断增加的认知障碍易导致谵妄，尤其是额叶/执行功能领域和回忆方面的缺陷。谵妄的长期风险应被视为整体脑血管疾病负担的一部分。
