Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea,
Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
Dement Geriatr Cogn Disord. 2022;51(2):168-174. doi: 10.1159/000523981. Epub 2022 Apr 21.
Ischemic stroke can cause impairment of daily function and cognitive function. Higher cognitive function is reported in many studies to be associated with better functional outcomes; however, evidence from longitudinal study is lacking. Therefore, in the present study, the association between cognitive function and longitudinal changes of functional outcome was investigated based on stroke severity. Furthermore, whether the effect of cognitive function remained consistent after controlling for depression was investigated.
The data of 423 stroke patients (292 minor strokes, 93 moderate strokes, and 38 severe strokes) were collected. Baseline Mini-Mental State Examination (MMSE) score was considered a predictor, and change of modified Rankin Scale (mRS) score during 12 months of follow-up was the outcome. First, the association between the baseline MMSE score and longitudinal change in the mRS score was analyzed using linear mixed-effects models. Fixed effects were MMSE score group, time, and MMSE score group × time interaction. Additional adjustment was made for the Geriatric Depression Scale (GDS) score.
Among the 423 subjects, the mean age was 73.5 years, and 43.4% were female. In the minor stroke group, the high MMSE score group had a decreased mRS score, and the low MMSE score group had an increased mRS score (p < 0.001). This association remained after additional adjustment of the GDS score. Association was not observed between cognitive function and functional recovery in the moderate or severe stroke group.
After ischemic stroke, higher baseline global cognitive function was a predictive factor for better functional recovery regardless of depression symptoms in the minor stroke group.
缺血性脑卒中可导致日常功能和认知功能受损。许多研究报告称，较高的认知功能与更好的功能结局相关；然而，缺乏纵向研究的证据。因此，本研究基于卒中严重程度，探讨了认知功能与功能结局纵向变化的关系。此外，还探讨了在控制抑郁症状后，认知功能的作用是否保持一致。
共纳入 423 例卒中患者（292 例轻度卒中、93 例中度卒中、38 例重度卒中）。基线简易精神状态检查（MMSE）评分作为预测指标，随访 12 个月时改良 Rankin 量表（mRS）评分的变化为结局。首先，采用线性混合效应模型分析基线 MMSE 评分与 mRS 评分纵向变化之间的关系。固定效应为 MMSE 评分组、时间和 MMSE 评分组×时间交互作用。此外，还对老年抑郁量表（GDS）评分进行了调整。
423 例受试者中，平均年龄为 73.5 岁，43.4%为女性。在轻度卒中组中，高 MMSE 评分组 mRS 评分降低，低 MMSE 评分组 mRS 评分升高（p<0.001）。这种相关性在进一步调整 GDS 评分后仍然存在。在中度或重度卒中组，认知功能与功能恢复之间没有关联。
在缺血性卒中后，无论是否存在抑郁症状，较高的基线总体认知功能是轻度卒中组更好的功能恢复的预测因素。
