Tatemichi T K, Paik M, Bagiella E, Desmond D W, Pirro M, Hanzawa L K
Department of Neurology (Stroke and Aging Research Project), Columbia University, College of Physicians and Surgeons, New York, NY.
Stroke. 1994 Oct;25(10):1915-9. doi: 10.1161/01.str.25.10.1915.
The aim of this study was to determine whether dementia after stroke adversely influences long-term survival.
Subjects were 251 patients > or = 60 years of age with ischemic stroke who were given neurological, neuropsychological, and functional examinations 3 months after hospitalization and were followed up prospectively. Using criteria modified from the Diagnostic and Statistical Manual of Mental Disorders-III-R, dementia was found in 66 (26.3%) patients at the 3-month baseline examination. Life-table methods were used to estimate mortality rates in the groups with and without dementia after 1 to 5 years of follow-up, Kaplan-Meier curves to estimate the cumulative proportion surviving with and without dementia, and Cox proportional-hazards analysis to compute the relative risk of mortality associated with dementia at baseline, after adjusting for other potential predictors of stroke mortality.
The mortality rate was 19.8 deaths per 100 person-years with dementia compared with 6.9 deaths per 100 person-years without dementia. The cumulative proportion surviving after a median follow-up of 58.6 months was 38.9 +/- 0.08% for those with dementia and 74.5 +/- 0.04% for those without dementia. The relative risk associated with dementia was 3.11 (95% confidence interval, 1.79 to 5.41) after adjusting for the effects of demographic factors, cardiac disease, severity of stroke (Barthel Index), stroke type (lacunar versus nonlacunar), and recurrent stroke (examined as a time-dependent variable). When the Mini-Mental State Examination score at baseline was examined instead of the diagnosis of dementia, the results of the model were similar.
Our study is the first to demonstrate that dementia or cognitive impairment adversely influences long-term survival after stroke, even after adjusting for other commonly accepted predictors of stroke mortality. Impairment in intellectual function after stroke, independent of physical disability, has a significant impact on prognosis. Both cognitive and physical functions should be assessed in clinical studies of stroke outcome.
本研究旨在确定卒中后痴呆是否会对长期生存产生不利影响。
研究对象为251例年龄≥60岁的缺血性卒中患者，在住院3个月后接受了神经学、神经心理学和功能检查，并进行前瞻性随访。采用《精神障碍诊断与统计手册》第三版修订本（DSM-III-R）修改后的标准，在3个月的基线检查中，66例（26.3%）患者被发现患有痴呆。采用生命表法估计随访1至5年后有痴呆组和无痴呆组的死亡率，采用Kaplan-Meier曲线估计有痴呆和无痴呆患者的累积生存比例，并采用Cox比例风险分析计算在调整其他潜在的卒中死亡率预测因素后，与基线时痴呆相关的死亡相对风险。
有痴呆患者的死亡率为每100人年19.8例死亡，无痴呆患者为每100人年6.9例死亡。在中位随访58.6个月后，有痴呆患者的累积生存比例为38.9±0.08%，无痴呆患者为74.5±0.04%。在调整了人口统计学因素、心脏病、卒中严重程度（Barthel指数）、卒中类型（腔隙性与非腔隙性）和复发性卒中（作为时间依赖性变量进行检查）的影响后，与痴呆相关的相对风险为3.11（95%置信区间，1.79至5.41）。当检查基线时的简易精神状态检查评分而非痴呆诊断时，模型结果相似。
我们的研究首次表明，即使在调整了其他公认的卒中死亡率预测因素后，痴呆或认知障碍仍会对卒中后的长期生存产生不利影响。卒中后智力功能障碍独立于身体残疾，对预后有重大影响。在卒中结局的临床研究中，应同时评估认知和身体功能。
