Department of Psychology University of Alabama at Birmingham Birmingham AL.
Department of Biostatistics University of Alabama at Birmingham Birmingham AL.
J Am Heart Assoc. 2024 Aug 6;13(15):e033375. doi: 10.1161/JAHA.123.033375. Epub 2024 Jul 26.
Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke severity ratings and a caregiver-report of poststroke functioning with longitudinal cognitive outcomes.
One hundred fifty-seven caregivers and stroke survivor dyads participated in the CARES (Caring for Adults Recovering From the Effects of Stroke) project, an ancillary study of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) national cohort study. The Glasgow Outcome Scale and modified Rankin Scale scores collected at hospitalization discharge were included as 2 primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at 9 months following stroke were included as a third predictor. Cognition was measured using a biennial telephone battery and included the domains of learning, memory, and executive functioning. Multiple cognitive assessments were analyzed up to 5 years poststroke, controlling for prestroke cognition and demographic variables of the stroke survivor. Separate mixed models showed significant main effects of the Glasgow Outcome Scale (b=0.3380 [95% CI, 0.14-0.5]; =0.0009), modified Rankin Scale (b=-0.2119 [95% CI, -0.32 to -0.10]; =0.0002), and caregiver-reported problems (b=-0.0671 [95% CI, -0.09 to -0.04]; <0.0001) on longitudinal cognitive scores. In a combined model including all 3 predictors, only caregiver-reported problems significantly predicted cognition (b=-0.0480 [95% CI, -0.08 to -0.03]; <0.0001).
These findings emphasize the importance of caregiver feedback in predicting cognitive consequences of stroke.
卒中后认知障碍很常见，多达 60%的幸存者存在认知障碍。卒中严重程度（由体积和位置表示）是认知障碍最重要的预测因素，严重卒中预测认知障碍的可能性更高。目前的研究考察了 2 种卒中严重程度评分和卒中后功能的 caregiver报告与纵向认知结果的关联。
157 名护理人员和卒中幸存者对参与 CARES（照顾从卒中影响中恢复的成年人）项目，该项目是 REGARDS（卒中地理和种族差异的原因）国家队列研究的辅助研究。住院出院时收集的格拉斯哥结局量表和改良 Rankin 量表评分被纳入认知障碍的 2 个主要预测因素。卒中后 9 个月护理人员报告的问题和障碍数量被纳入第三个预测因素。认知使用每两年一次的电话电池进行测量，包括学习、记忆和执行功能领域。对多达 5 年的卒中后多个认知评估进行了分析，控制了卒中幸存者的术前认知和人口统计学变量。单独的混合模型显示格拉斯哥结局量表（b=0.3380[95%CI，0.14-0.5]；=0.0009）、改良 Rankin 量表（b=-0.2119[95%CI，-0.32 至-0.10]；=0.0002）和护理人员报告的问题（b=-0.0671[95%CI，-0.09 至-0.04]；<0.0001）对纵向认知评分有显著的主要影响。在包括所有 3 个预测因素的综合模型中，只有护理人员报告的问题显著预测认知（b=-0.0480[95%CI，-0.08 至-0.03]；<0.0001）。
这些发现强调了 caregiver 反馈在预测卒中认知后果中的重要性。
