Dec-Ćwiek Małgorzata, Wrona Paweł, Homa Tomasz, Słowik Joanna, Bodzioch Aleksandra, Słowik Agnieszka
Department of Neurology, Jagiellonian University in Krakow, Collegium Medicum, Krakow, Poland.
Department of Experimental Dentistry and Dental Prophylaxis, Jagiellonian University, Medical College, Krakow, Poland.
Int J Geriatr Psychiatry. 2025 May;40(5):e70087. doi: 10.1002/gps.70087.
Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iBioStroke study (n = 1042), 90 days after their first ischemic stroke.
We prospectively analyzed data from 582 participants, without cognitive problems before stroke based on the structured interview with the patient, a family member or a caregiver, and/or clinical documentation (if available), who completed the Montreal Cognitive Assessment (MoCA) at discharge and 90 days post-stroke. Two MoCA cut-offs were used to define PSCI: a score of ≤ 25 in the first model and ≤ 22 in the second model. Multivariate logistic regression was employed to identify independent risk factors for PSCI based on 30 collected parameters.
In the first model, PSCI was identified in 418 (71.8%) participants at day 90. Independent risk factors included older age (OR = 1.05; 95% CI:1.02-1.08), fewer years of education (OR = 0.83; 95% CI: 0.73-0.93), lower MoCA scores at discharge (OR = 0.76; 95% CI: 0.69-0.84), higher anxiety levels (HADS-A) at day 90 (OR = 1.10; 95% CI: 1.01-1.21), and larger stroke volume (OR = 1.01; 95% CI: 1.00-1.01). In the second model, PSCI was observed in 294 (50.5%) participants. Older age (OR = 1.06; 95% CI: 1.03-1.09), fewer years of education (OR = 0.87; 95% CI: 0.78-0.96), lower MoCA scores at discharge (OR = 0.83; 95% CI: 0.77-0.88), and higher depression levels (HADS-D) at day 90 (OR = 1.10; 95% CI: 1.03-1.18) were significant predictors.
Based on our data, PSCI seems to be a common consequence of stroke. Both irreversible factors, such as age and educational level, stroke volume, and potentially modifiable factors, including post-stroke anxiety or depression and acute cognitive impairment, contribute to PSCI risk. These findings underscore the importance of early cognitive and psychiatric interventions in stroke survivors.
卒中后认知障碍（PSCI）在卒中幸存者中很常见，对长期预后产生负面影响。我们旨在评估iBioStroke研究（n = 1042）中参与者在首次缺血性卒中后90天PSCI的患病率及其危险因素。
我们前瞻性分析了582名参与者的数据，这些参与者在卒中前没有认知问题，这是基于对患者、家庭成员或护理人员的结构化访谈和/或临床记录（如有）得出的结论，他们在出院时和卒中后90天完成了蒙特利尔认知评估（MoCA）。使用两个MoCA临界值来定义PSCI：第一个模型中分数≤25分，第二个模型中分数≤22分。基于收集的30个参数，采用多变量逻辑回归来确定PSCI的独立危险因素。
在第一个模型中，90天时在418名（71.8%）参与者中发现了PSCI。独立危险因素包括年龄较大（OR = 1.05；95%CI：1.02 - 1.08）、受教育年限较少（OR = 0.83；95%CI：0.73 - 0.93）、出院时MoCA分数较低（OR = 0.76；95%CI：0.69 - 0.84）、90天时焦虑水平较高（医院焦虑抑郁量表 - 焦虑分量表[HADS - A]）（OR = 1.10；95%CI：1.01 - 1.21）和梗死体积较大（OR = 1.01；95%CI：正文1.00 - 1.01）。在第二个模型中，在294名（50.5%）参与者中观察到PSCI。年龄较大（OR = 1.06；95%CI：1.03 - 1.09）、受教育年限较少（OR = 0.87；95%CI：0.78 - 0.96）、出院时MoCA分数较低（OR = 0.83；95%CI：0.77 -正文0.88）和90天时抑郁水平较高（医院焦虑抑郁量表 - 抑郁分量表[HADS - D]）（OR = 1.10；95%CI：1.03 - 1.18）是显著的预测因素。
根据我们的数据，PSCI似乎是卒中的常见后果。年龄、教育水平、梗死体积等不可逆转的因素，以及卒中后焦虑或抑郁和急性认知障碍等潜在可改变的因素，都增加了PSCI的风险。这些发现强调了对卒中幸存者进行早期认知和心理干预的重要性。
