Pinguet Valentin, Duloquin Gauthier, Thibault Thomas, Devilliers Hervé, Comby Pierre-Olivier, Crespy Valentin, Ricolfi Frédéric, Vergely Catherine, Giroud Maurice, Béjot Yannick
Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neuroimaging, University Hospital of Dijon, France.
Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, 14 rue Paul Gaffarel, Dijon 21079, France; Department of Neurology, University Hospital of Dijon, France.
J Neuroradiol. 2023 Feb;50(1):16-21. doi: 10.1016/j.neurad.2022.03.001. Epub 2022 Mar 11.
We evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS).
IS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity.
Among the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages.
Impaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.
我们评估了既往脑损伤是否可以解释缺血性卒中（IS）认知障碍患者病情更严重的原因。
从法国第戎基于人群的登记处检索IS患者。在初始CT扫描上评估既往损伤（脑白质疏松、陈旧性脑血管病变、皮质和中枢脑萎缩）。使用有序回归分析评估卒中前认知状态（定义为无损害、轻度认知障碍[MCI]或痴呆）与IS发作时用美国国立卫生研究院卒中量表（NIHSS）评分评估的临床严重程度之间的关联。进行中介分析以评估既往脑损伤作为认知状态与严重程度之间关系的中介因素。
在纳入的916例患者（平均年龄76.8±15.0岁，54.3%为女性）中，在单因素分析中，既往有MCI（n = 115，NIHSS中位数[四分位间距]：6[2 - 15]）或痴呆（n = 147，NIHSS中位数：6[3 - 15]）的患者比无上述情况的患者（n = 654，NIHSS中位数：3[1 - 9]）病情更严重（OR = 1.69；95%置信区间：1.18 - 2.42，p = 0.004；OR = 2.06；95%置信区间：1.49 - 2.84，p < 0.001）。陈旧性皮质病变（OR = 1.53，p = 0.002）、中枢萎缩（OR = 1.41，p = 0.005）、皮质萎缩（OR = 1.90，p < 0.001）以及中度（OR = 1.41，p = 0.005）或重度（OR = 1.84，p = 0.002）脑白质疏松也与病情更严重相关。调整后，既往MCI（OR = 1.52；95%置信区间：1.03 - 2.26，p = 0.037）或痴呆（OR = 1.94；95%置信区间：1.32 - 2.86，p = 0.001）在IS发作时仍与更高的严重程度相关，独立于包括影像学变量在内的混杂因素。认知障碍与严重程度之间的关联并非由既往可见脑损伤介导。
既往有认知障碍的IS患者脑缺血耐受性受损可能涉及除既往可见脑损伤之外的其他机制。
