Department of Neurology (C.J.B., D.A.L., N.G., R.L., M.V.S., D.B.Z., L.B.M.), University of Michigan Medical School, Ann Arbor.
Institute for Social Research, University of Michigan, Ann Arbor (S.G.H., W.C., K.M.L.).
Stroke. 2022 Nov;53(11):3394-3400. doi: 10.1161/STROKEAHA.122.039533. Epub 2022 Aug 12.
The association between stroke and dementia is well established. Less is known about this association in underrepresented ethnic groups. In a large ethnically diverse cohort, we examined whether history of stroke was associated with cognitive impairment, and whether this relationship differed by ethnicity (Mexican American [MA] versus non-Hispanic White).
This was a population-based cohort study conducted in Nueces County, TX, a biethnic community with a large and primarily nonimmigrant MA population. Residents aged ≥65 were recruited door-to-door or by telephone between May 2018 and December 2021. The primary exposure was history of stroke, obtained by self-report. Demographic, medical, and educational histories were also obtained. The primary outcome was the Montreal Cognitive Assessment (MoCA), a scale that evaluates multiple domains of cognitive performance. Scores were divided into 3 ordinal categories, roughly corresponding to normal cognition (MoCA 26-30), mild cognitive impairment (MoCA 20-25), or probable dementia (MoCA 0-19).
One thousand eight hundred one participants completed MoCA screening (55% female; 50% MA, 44% Non-Hispanic White, 6% other), of whom 12.4% reported history of stroke. Stroke prevalence was similar across ethnicities (X 2.1; =0.34). In a multivariable cumulative logit regression model for the ordinal cognition outcome, a stroke by ethnicity interaction was observed (=0.01). Models stratified by ethnicity revealed that stroke was associated with cognitive impairment across ethnicities, but had greater impact on cognition in non-Hispanic Whites (cumulative odds ratio=3.81 [95% CI, 2.37-6.12]) than in MAs (cumulative odds ratio=1.58 [95% CI, 1.04-2.41]). Increased age and lower educational attainment were also associated with cognitive impairment, regardless of ethnicity.
History of stroke was associated with increased odds of cognitive impairment after controlling for other factors in both MA and Non-Hispanic White participants. The magnitude of the impact of stroke on cognition was less in MA than in Non-Hispanic White participants.
中风和痴呆之间存在关联，这一点已得到充分证实。在代表性不足的少数族裔群体中，人们对这种关联的了解较少。在一个种族多样化的大型队列中，我们研究了中风史是否与认知障碍有关，以及这种关系是否因族裔（墨西哥裔美国人[MA]与非西班牙裔白人）而异。
这是一项基于人群的队列研究，在德克萨斯州努埃塞斯县进行，该社区是一个拥有大量主要是非移民 MA 人口的双种族社区。2018 年 5 月至 2021 年 12 月，通过上门或电话招募年龄≥65 岁的居民。主要暴露因素是中风史，通过自我报告获得。还获取了人口统计学、医学和教育史信息。主要结局指标是蒙特利尔认知评估量表（MoCA），这是一种评估认知表现多个领域的量表。评分分为 3 个有序类别，大致对应于正常认知（MoCA 26-30）、轻度认知障碍（MoCA 20-25）或可能的痴呆（MoCA 0-19）。
1801 名参与者完成了 MoCA 筛查（55%为女性；50%为 MA，44%为非西班牙裔白人，6%为其他族裔），其中 12.4%报告有中风史。不同族裔之间的中风患病率相似（X 2=2.1；=0.34）。在针对有序认知结果的多变量累积对数回归模型中，观察到中风与族裔之间存在交互作用（=0.01）。按族裔分层的模型显示，中风与认知障碍在所有族裔中均相关，但在非西班牙裔白人群体中对认知的影响更大（累积优势比=3.81[95%置信区间，2.37-6.12]），而非 MA 人群中（累积优势比=1.58[95%置信区间，1.04-2.41]）。无论族裔如何，年龄增长和受教育程度较低也与认知障碍有关。
在控制 MA 和非西班牙裔白人群体中的其他因素后，中风史与认知障碍的几率增加有关。中风对认知的影响在 MA 人群中比在非西班牙裔白人群体中要小。
