Moroney J T, Bagiella E, Desmond D W, Paik M C, Stern Y, Tatemichi T K
Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Stroke. 1996 Aug;27(8):1283-9. doi: 10.1161/01.str.27.8.1283.
Stroke significantly increases the risk of dementia in the elderly, yet the risk factors for incident dementia after ischemic stroke are not well understood. We attempted to determine whether hypoxic-ischemic (HI) disorders, which may result from comorbid medical conditions (eg. seizures, cardiac arrhythmias, pneumonia), would be an independent risk factor for the development of new dementia after stroke.
We prospectively followed 185 initially nondemented patients with ischemic stroke (age, 70.3 +/- 7.7 years) for a maximum of 52.8 months. We diagnosed the presence of dementia at annual examinations based on neuropsychological testing and modified DSM-III-R criteria. HI disorders were identified by record review or examination during hospitalization. We used Kaplan-Meier analysis to determine the cumulative proportion of patients with and without HI disorders who survived free of dementia and used Cox models to estimate the relative risk of dementia associated with HI disorders.
The cumulative proportion (+/- SE) surviving without dementia was 51.7 +/- 10.9% in the HI group versus 78.2 +/- 4.3% in the non-HI group after 52.8 months of observation. The relative risk of incident dementia associated with HI events was 4.3 (95% confidence interval = 1.9 to 9.6) after we adjusted for demographic factors, recurrent stroke, and baseline cognitive function.
We conclude that HI disorders may be a significant independent risk factor for incident dementia after stroke, even after adjustment for other recognized predictors of cognitive decline. Recognition of HI cerebral damage as a possible pathogenic mechanism for dementia after stroke may allow targeted therapeutic interventions to prevent subsequent cognitive deterioration.
中风显著增加了老年人患痴呆症的风险，但缺血性中风后新发痴呆症的危险因素尚未完全明确。我们试图确定由合并症（如癫痫、心律失常、肺炎）导致的缺氧缺血性（HI）疾病是否会成为中风后新发痴呆症的独立危险因素。
我们对185例最初无痴呆症的缺血性中风患者（年龄70.3±7.7岁）进行了为期最长52.8个月的前瞻性随访。我们根据神经心理学测试和修订的DSM-III-R标准在年度检查时诊断痴呆症的存在。HI疾病通过住院期间的记录审查或检查来确定。我们使用Kaplan-Meier分析来确定有无HI疾病且未患痴呆症存活患者的累积比例，并使用Cox模型来估计与HI疾病相关的痴呆症相对风险。
经过52.8个月的观察，HI组未患痴呆症存活的累积比例（±SE）为51.7±10.9%，而非HI组为78.2±4.3%。在我们对人口统计学因素、复发性中风和基线认知功能进行调整后，与HI事件相关的新发痴呆症相对风险为4.3（95%置信区间=1.9至9.6）。
我们得出结论，HI疾病可能是中风后新发痴呆症的一个重要独立危险因素，即使在对其他公认的认知衰退预测因素进行调整之后。将HI脑损伤识别为中风后痴呆症的一种可能致病机制，可能有助于采取针对性的治疗干预措施来预防随后的认知恶化。
