Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France.
Neuroepidemiology. 2023;57(5):345-354. doi: 10.1159/000533389. Epub 2023 Aug 7.
Understanding the influence of preexisting cognitive impairment on the poststroke outcome is a critical challenge in the context of current aging and growing population. This study aimed to assess long-term survival of patients with acute ischemic stroke (IS) according to their premorbid cognitive status and to identify contributing factors of death.
Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). The association between case fatality at 5 years and prestroke cognitive status was assessed by multivariable Cox models adjusted for other clinical characteristics and preexisting brain damage on the initial CT scan including leukoaraiosis, old vascular brain lesions, and cortical and central brain atrophy, as well as major arterial occlusion.
1,049 patients were included (mean age ± SD: 76.3 ± 15.2 years old, 54% women). Case fatality rates at 5 years were 38.1% in patients without cognitive impairment, 65.9% in patients with prior mild cognitive impairment (MCI, n = 132, 12.6%), and 86.6% in patients with dementia (n = 164, 15.6%) (p < 0.001). MCI (HR = 1.39; 95% CI: 1.06-1.81, p = 0.016) and dementia (HR = 1.89; 95% CI: 1.45-2.46, p < 0.001) were both independently associated with higher case fatality after adjustment for clinical variables. The association remained significant after further adjustment for preexisting brain damage and major arterial occlusion (HR = 1.47; 95% CI: 1.10-1.98, p = 0.009, for MCI and HR = 1.90; 95% CI: 1.43-2.53, p < 0.001, for dementia) among patients with available data on the CT scan (n = 916). Factors associated with death were roughly similar across groups.
This study highlighted a poor long-term survival of IS patients with preexisting cognitive impairment, independently of other contributing factors of death. It is critical to better understand the trajectory of IS patients with preexisting cognitive impairment and to identify prognostic markers to guide clinicians in their management strategies.
了解认知障碍对卒中后结局的影响是当前老龄化和人口增长背景下的一个关键挑战。本研究旨在评估急性缺血性卒中（IS）患者根据其发病前认知状态的长期生存情况，并确定死亡的相关因素。
采用基于人群的登记系统（2013-2017 年），前瞻性地在法国第戎的居民中识别 IS 患者。采用多变量 Cox 模型评估 5 年病死率与发病前认知状态之间的关系，并对其他临床特征和初始 CT 扫描上的预先存在的脑损伤进行调整，包括脑白质疏松症、陈旧性血管性脑病变、皮质和中央脑萎缩以及主要动脉闭塞。
共纳入 1049 例患者（平均年龄±标准差：76.3±15.2 岁，54%为女性）。无认知障碍患者 5 年病死率为 38.1%，轻度认知障碍（MCI，n=132，12.6%）患者为 65.9%，痴呆（n=164，15.6%）患者为 86.6%（p＜0.001）。MCI（HR=1.39；95%CI：1.06-1.81，p=0.016）和痴呆（HR=1.89；95%CI：1.45-2.46，p＜0.001）在调整临床变量后均与更高的病死率独立相关。在进一步调整预先存在的脑损伤和主要动脉闭塞后，这种相关性仍然显著（MCI：HR=1.47；95%CI：1.10-1.98，p=0.009；痴呆：HR=1.90；95%CI：1.43-2.53，p＜0.001），（n=916，CT 扫描数据可用）。死亡相关因素在各组间大致相似。
本研究强调了伴有预先存在认知障碍的 IS 患者的长期预后不良，独立于其他死亡相关因素。更好地了解伴有预先存在认知障碍的 IS 患者的病程并确定预后标志物，以指导临床医生的管理策略至关重要。
