Desmond D W, Moroney J T, Bagiella E, Sano M, Stern Y
Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Stroke. 1998 Jan;29(1):69-74. doi: 10.1161/01.str.29.1.69.
Although it is understood that dementia is a risk factor for adverse outcomes, little is known about the predictive validity of the numerous methods that have been proposed for its diagnosis. Thus, we performed the present study to assess the utility of a variety of diagnostic methods in the prediction of adverse outcomes following stroke.
We administered neuropsychological, neurological, and functional examinations to 244 patients (age, 71.7+/-8.5 years) 3 months after ischemic stroke. We diagnosed dementia using each of the following methods: (1) neuropsychological testing, requiring deficits in increasing numbers of cognitive domains, both with and without memory impairment, as well as functional impairment; (2) Mini-Mental State Examination (MMSE) score of <24; and (3) neurologists' clinical judgment. We then used survival analyses to investigate the ability of diagnoses based on those methods to predict death and recurrent stroke during long-term follow-up.
Log-rank tests and Cox proportional hazards analyses, with recurrent stroke entered as a time dependent covariate, determined that all of the paradigms were significant predictors of mortality, but the performance of paradigms based on neuropsychological testing was superior to the use of the MMSE and clinical judgment, particularly when memory impairment was required. Log-rank tests determined that paradigms based on neuropsychological testing were the only significant predictors of recurrent stroke and performed best when memory impairment was required.
Our results suggest that dementia diagnosis based on neuropsychological assessment and an operationalized paradigm requiring deficits in memory and other cognitive domains is superior to other conventional methods in its ability to identify patients at elevated risk of adverse outcomes following stroke.
尽管人们知道痴呆是不良预后的一个风险因素，但对于已提出的众多痴呆诊断方法的预测效度却知之甚少。因此，我们开展了本研究，以评估多种诊断方法在预测卒中后不良预后方面的效用。
我们对244例缺血性卒中后3个月的患者（年龄71.7±8.5岁）进行了神经心理学、神经学和功能检查。我们采用以下每种方法诊断痴呆：（1）神经心理学测试，要求在越来越多的认知领域存在缺陷，无论有无记忆损害以及功能损害；（2）简易精神状态检查表（MMSE）得分＜24；（3）神经科医生的临床判断。然后，我们使用生存分析来研究基于这些方法的诊断在长期随访期间预测死亡和复发性卒中情况的能力。
以复发性卒中作为时间依赖性协变量的对数秩检验和Cox比例风险分析确定，所有这些模式都是死亡率的显著预测因素，但基于神经心理学测试的模式的表现优于使用MMSE和临床判断，特别是在需要记忆损害的情况下。对数秩检验确定，基于神经心理学测试的模式是复发性卒中的唯一显著预测因素，并且在需要记忆损害时表现最佳。
我们的结果表明，基于神经心理学评估以及要求存在记忆和其他认知领域缺陷的可操作模式进行的痴呆诊断，在识别卒中后不良预后风险升高患者的能力方面优于其他传统方法。
