School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
Alzheimers Res Ther. 2024 May 18;16(1):111. doi: 10.1186/s13195-024-01479-8.
Cognitive impairment is common after stroke, and a large proportion of stroke patients will develop dementia. However, there have been few large prospective studies which have assessed cognition both prior to and after stroke. This study aims to determine the extent to which incident stroke impacts different domains of cognitive function in a longitudinal cohort of older community-dwelling individuals.
19,114 older individuals without cardiovascular disease or major cognitive impairment were recruited and followed over a maximum 11 years. Stroke included ischaemic and haemorrhagic stroke and was adjudicated by experts. Cognitive function was assessed regularly using Modified Mini-Mental State Examination (3MS), Hopkins Verbal Learning Test-Revised (HVLT-R), Symbol Digit Modalities Test (SDMT), and Controlled Oral Word Association Test (COWAT). Linear mixed models were used to investigate the change in cognition at the time of stroke and decline in cognitive trajectories following incident stroke.
During a median follow-up period of 8.4 [IQR: 7.2, 9.6] years, 815 (4.3%) participants experienced a stroke. Over this time, there was a general decline observed in 3MS, HVLT-R delayed recall, and SDMT scores across participants. However, for individuals who experienced a stroke, there was a significantly greater decline across all cognitive domains immediately after the event immediately after the event (3MS: -1.03 [95%CI: -1.45, -0.60]; HVLT-R: -0.47 [-0.70, -0.24]; SDMT: -2.82 [-3.57, -2.08]; COWAT: -0.67 [-1.04, -0.29]) and a steeper long-term decline for three of these domains (3MS -0.62 [-0.88, -0.35]; COWAT: -0.30 [-0.46, -0.14]); HVLT-R: -0.12 [95%CI, -0.70, -0.24]). However individuals with stroke experienced no longer-term decline in SDMT compared to the rest of the participants.
These findings highlight the need for comprehensive neuropsychology assessments for ongoing monitoring of cognition following incident stroke; and potential early intervention.
认知障碍在中风后很常见，很大一部分中风患者会发展为痴呆症。然而，很少有大型前瞻性研究在中风前后评估认知功能。本研究旨在确定在一项针对老年社区居住者的纵向队列研究中，中风对不同认知功能领域的影响程度。
共招募了 19114 名无心血管疾病或严重认知障碍的老年人，随访时间最长为 11 年。中风包括缺血性和出血性中风，并由专家进行裁决。使用改良简易精神状态检查（3MS）、霍普金斯词语学习测试修订版（HVLT-R）、符号数字模态测试（SDMT）和受控词语联想测试（COWAT）定期评估认知功能。线性混合模型用于研究中风时认知的变化以及中风后认知轨迹的下降。
在中位随访期为 8.4 年[IQR：7.2，9.6]的时间内，815 名（4.3%）参与者发生了中风。在此期间，所有参与者的 3MS、HVLT-R 延迟回忆和 SDMT 评分均呈下降趋势。然而，对于发生中风的个体，在事件发生后所有认知领域的下降更为显著（3MS：-1.03[95%CI：-1.45，-0.60]；HVLT-R：-0.47[-0.70，-0.24]；SDMT：-2.82[-3.57，-2.08]；COWAT：-0.67[-1.04，-0.29]），并且这些领域中的三个领域的长期下降更为陡峭（3MS-0.62[-0.88，-0.35]；COWAT：-0.30[-0.46，-0.14]）；HVLT-R：-0.12[95%CI，-0.70，-0.24]）。然而，与其余参与者相比，中风患者的 SDMT 没有长期下降。
这些发现强调了需要对中风后认知进行全面的神经心理学评估，以进行持续监测，并可能需要早期干预。
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