Hua Jianian, Zhou Yixiu, Chen Licong, Tang Xiang, Diao Shanshan, Fang Qi
Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Emergency, Children's Hospital of Soochow University, Suzhou, China.
Front Neurol. 2022 Aug 5;13:917295. doi: 10.3389/fneur.2022.917295. eCollection 2022.
Cognitive impairment may affect one-third of stroke survivors. Cardiovascular risk factors and stroke severity were known to be associated with cognitive function after stroke. However, it is unclear whether cardiovascular risk factors directly affect cognition after stroke, indirectly affect cognition by changing stroke severity, or both. Moreover, the effect of a combination of hypertension and diabetes mellitus was conflicting. We aimed to investigate the multiple direct and indirect associations and inspire potential intervention strategies.
From February 2020 to January 2021, 350 individuals received cognitive tests within 7 days after incident stroke. Cognitive tests were performed using the Chinese version of the Mini-Mental State Examination (MMSE). A moderated mediation model was constructed to test the indirect associations between cardiovascular and demographic risk factors and cognition mediated through stroke severity, the direct associations between risk factors and cognition, and the moderating effects of hypertension and diabetes.
Age (estimate, -0.112), atrial fibrillation (estimate, -4.092), and stroke severity (estimate, -1.994) were directly associated with lower cognitive function after stroke. Vascular disease (estimate, 1.951) and male sex (estimate, 2.502) were directly associated with better cognition after stroke. Higher education level was associated with better cognition directly (estimate, 1.341) and indirectly (estimate, 0.227) through stroke severity. The combination of hypertension decreased the magnitude of the negative association between atrial fibrillation and cognition (estimate, from -4.092 to -3.580).
This is the first Chinese study exploring the moderated and mediating associations between cardiovascular risk factors, stroke severity, and cognitive function after stroke. Age, female sex, and atrial fibrillation were directly associated with lower cognition after stroke. The combination of hypertension might have a positive effect on cognition.
认知障碍可能影响三分之一的中风幸存者。已知心血管危险因素和中风严重程度与中风后的认知功能相关。然而，尚不清楚心血管危险因素是直接影响中风后的认知，还是通过改变中风严重程度间接影响认知，亦或是两者皆有。此外，高血压和糖尿病联合作用的影响存在争议。我们旨在研究多种直接和间接关联，并启发潜在的干预策略。
2020年2月至2021年1月，350例个体在中风发病后7天内接受了认知测试。使用中文版简易精神状态检查表（MMSE）进行认知测试。构建了一个有调节的中介模型，以测试心血管和人口统计学危险因素与通过中风严重程度介导认知之间的间接关联、危险因素与认知之间的直接关联，以及高血压和糖尿病的调节作用。
年龄（估计值，-0.112）、心房颤动（估计值，-4.092）和中风严重程度（估计值，-1.994）与中风后较低的认知功能直接相关。血管疾病（估计值，1.951）和男性（估计值，2.502）与中风后较好的认知直接相关。较高的教育水平与较好的认知直接（估计值，1.341）和通过中风严重程度间接（估计值，0.227）相关。高血压的联合作用降低了心房颤动与认知之间负相关的程度（估计值，从-4.092降至-3.580）。
这是第一项探索中风后心血管危险因素、中风严重程度和认知功能之间有调节和中介关联的中国研究。年龄、女性性别和心房颤动与中风后较低的认知直接相关。高血压的联合作用可能对认知有积极影响。
