Ferrucci L, Guralnik J M, Salive M E, Pahor M, Corti M C, Baroni A, Havlik R J
Geriatric Department, National Research Institute, Florence, Italy.
J Am Geriatr Soc. 1996 Mar;44(3):237-41. doi: 10.1111/j.1532-5415.1996.tb00908.x.
Recent studies have suggested that vascular dementia in older persons is more common than previously hypothesized. A substantial proportion of dementia in old age may be an early manifestation of cerebrovascular disease (CVD), that eventually becomes clinically evident as an acute cerebrovascular accident. This study was aimed at assessing whether cognitive impairment and cognitive decline in older persons free of stroke are associated with higher risk of future stroke, independently of other risk factors.
Population-based prospective study.
A total of 5024 subjects from the Established Populations for Epidemiologic Studies of the Elderly, who were alive and had no history of previous stroke at the sixth follow-up visit. Subjects who had reported a stroke in a previous interview or with a diagnosis of cerebrovascular disease in a hospitalization record during the previous 3 years were excluded.
Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Occurrence of a stroke was prospectively assessed by examining hospital discharge diagnoses and death certificates.
During 19,533 person-years of follow-up, 259 strokes were recorded (13.3/1000 person-years). Stroke incidence was lowest in those with normal SPMSQ score (12.1/1000 person-years), intermediate in those with moderate impairment (16.3/1000 person-years), and highest in those with severe impairment (30.9/1000 person-years). Adjusting for age, education, smoking, history of hypertension, blood pressure, heart attack, diabetes, and disability, the relative risks of stroke for moderate and severe cognitive impairment were 1.2 (0.9-1.6) and 2.2 (1.2-3.8), respectively. The association between cognitive impairment and incident stroke was not mediated by hypertension or diabetes. Compared with subjects with stable or improved SPMSQ score in the previous 3 years, those who declined had higher risk of stroke.
The elevated risk of subsequent strokes in older persons with cognitive impairment suggests that CVD may play larger role in causing cognitive impairment then previously suspected. It remains to be demonstrated whether reducing modifiable risk factors for CVD decreases the burden of cognitive impairment in older persons without stroke.
近期研究表明，老年人血管性痴呆比之前推测的更为常见。老年痴呆的很大一部分可能是脑血管疾病（CVD）的早期表现，最终会以急性脑血管意外的形式在临床上显现出来。本研究旨在评估无中风的老年人认知障碍和认知衰退是否与未来中风的较高风险相关，且独立于其他风险因素。
基于人群的前瞻性研究。
来自老年流行病学研究既定人群的总共5024名受试者，他们在第六次随访时还活着且无既往中风史。排除在之前访谈中报告过中风或在过去3年住院记录中有脑血管疾病诊断的受试者。
通过简短便携式精神状态问卷（SPMSQ）评估认知功能。通过检查医院出院诊断和死亡证明前瞻性评估中风的发生情况。
在19533人年的随访期间，记录了259例中风（13.3/1000人年）。SPMSQ评分正常者的中风发病率最低（12.1/1000人年），中度受损者居中（16.3/1000人年），重度受损者最高（30.9/1000人年）。在调整年龄、教育程度、吸烟、高血压病史、血压、心脏病发作、糖尿病和残疾因素后，中度和重度认知障碍的中风相对风险分别为1.2（0.9 - 1.6）和2.2（1.2 - 3.8）。认知障碍与中风事件之间的关联并非由高血压或糖尿病介导。与在过去3年中SPMSQ评分稳定或改善的受试者相比，评分下降者中风风险更高。
认知障碍老年人后续中风风险升高表明，CVD在导致认知障碍方面可能比之前怀疑的发挥更大作用。对于无中风的老年人，降低CVD的可改变风险因素是否能减轻认知障碍负担仍有待证实。
