Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, 325 E. Eisenhower Blvd, Ann Arbor, MI 48108, United States.
Department of Epidemiology, University of Michigan School of Public Health and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 325 E. Eisenhower Blvd, Ann Arbor, MI 48108, United States.
J Stroke Cerebrovasc Dis. 2023 Feb;32(2):106902. doi: 10.1016/j.jstrokecerebrovasdis.2022.106902. Epub 2022 Nov 29.
We examined whether cognitive trajectories from 0-3 months after stroke differ between Mexican Americans (MAs) and non-Hispanic white (NHW) adults.
The sample included 701 participants with ischemic stroke (62% MA; 38% NHW) from the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project, between 2008-2013. The outcome was the modified Mini Mental State Examination (3MSE, range 0-100 lower scores worse). Linear mixed effects models were utilized to examine the association between ethnicity and cognitive trajectories from 0-3 months following stroke, adjusting for confounders.
MAs were younger, had lower educational attainment, and fewer had health insurance than NHWs (all p< 0.01). A smaller proportion of MAs were rated by informants as exhibiting pre-stroke cognitive decline than NHW (p < .0.05). After accounting for confounders, MAs demonstrated lower cognitive performance at post-stroke baseline and at 3-months following stroke (-2.00; 95% CI =-3.92, -0.07). Cognitive trajectories from 0-3 months following stroke were indicative of modest cognitive recovery (increase of 0.034/day, 95% CI =0.030-0.036) and did not differ between MAs and NHWs (p = 0.68).
We found no evidence that cognitive trajectories in the first three months following stroke differed between MAs and NHWs. MAs demonstrated lower cognitive performance shortly after stroke and at three months following stroke compared to NHWs. Further research is needed to identify factors contributing to ethnic disparities in cognitive outcomes after stroke.
我们研究了在中风后 0-3 个月期间,墨西哥裔美国成年人(MA)与非西班牙裔白人(NHW)的认知轨迹是否存在差异。
该样本包括 2008-2013 年间来自基于人群的中风监测研究——科珀斯克里斯蒂大脑攻击监测(BASIC)项目的 701 名缺血性中风患者(62%为 MA;38%为 NHW)。结局为改良后的 Mini 精神状态检查(3MSE,范围为 0-100,得分越低表示认知功能越差)。采用线性混合效应模型,调整混杂因素后,检验种族与中风后 0-3 个月认知轨迹之间的关系。
与 NHW 相比,MA 更年轻、受教育程度更低、拥有医疗保险的比例更少(均 P<0.01)。与 NHW 相比,更少的 MA 被知情者评定为存在中风前认知能力下降(P<0.05)。在调整混杂因素后,MA 在中风后基线和 3 个月时的认知表现更差(-2.00;95%CI=-3.92,-0.07)。从 0-3 个月的认知轨迹表明存在适度的认知恢复(每天增加 0.034,95%CI=0.030-0.036),且在 MA 和 NHW 之间没有差异(P=0.68)。
我们没有发现证据表明 MA 和 NHW 在中风后前三个月的认知轨迹存在差异。与 NHW 相比,MA 在中风后和 3 个月时的认知表现更差。需要进一步研究以确定导致中风后认知结局存在种族差异的因素。