Association of Hyperlipidaemia with Vascular Dementia among Stroke Patients Attending a Tertiary Level Hospital in Bangladesh

Bangladesh Journal of Neuroscience Pub Date : 2016-01-31 DOI:10.3329/bjn.v32i1.57406

Nayeem Anwar, Md Rezaul Karim Khan, -. Md Shahidullah, Nawreen Binte Anwar, S. Nahar

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Abstract

Background: Stroke is a major cause of physical disability in the elderly and the second most common cause of dementia. The prevalence of Alhzeimer’s dementia is increasing in western societies. But vascular dementia (VaD) is increasing in developing countries like Bangladesh and in Japan, because of the decline in mortality after stroke and aging of population. Conflicting data shows that hyperlipidaemia, a modifiable risk factor for ischemic stroke is associated with a higher risk of vascular dementia. Objective: The objective of this study was to evaluate association of hyperlipidaemia with vascular dementia. Method: It was a cross-sectional descriptive study conducted in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from August 2014 to November, 2015. All stroke patients above 18 years of age and both sexes, attending the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka presenting at least 3 months after stroke were the study population. Patients attending to the above mentioned hospital and after meeting the inclusion and exclusion criteria a purposive sampling technique were applied for selecting cases. Total 73 cases were evaluated. These patients were examined by MMSE for evidence of dementia. Severity and risk factors of vascular dementia were assessed. Serum fasting lipid profile was estimated in all cases and evaluated their association with VaD. Results: In this study it was observed that most of the stroke patients and VaD patients were in the age group of 5th and 6th decade. Among stroke patients it was 17(23.3%) and 31(42.5%) and among VaD patients it was 10(25.6%) and 18 (46.6%). Male outnumbered female (in stroke male-63%, Female-37%; in VaD male-59%, Female 41%). In this study out of 73 patients 40(54.8%) were smoker, 67(91.8%) had hyperlipidemia, 54(74%) had hypertension, 35(47.9%) had diabetes mellitus, 15 (20.5%) had IHD, 64(87.7%) had ischemic stroke, 9(12.3%) had hemorrhagic stroke, 25(34.25%) had recurrent stroke. Most of the patients were house-wife 16((21.9%) and read upto primary level 22 (30%). Out of 73 stroke patients 39(53.4%) had VaD. Of them 12(30.8%) had mild, 16(41%) had moderate and 11(28.2%) had severe dementia. Again out of 39 VaD patients 38(97.4%) had history of ischemic stroke and 1(2.6%) had history of hemorrhagic stroke who was moderately demented. Among VaD and non-vascular dementia patients the mean S. total cholesterol, S. triglyceride, S. LDL-C and S.HDL-C were 185.35±44.07, 149.82±57.05, 133.58±44.53, 31.07±11.16 (mg/dl) and 178.70±48.40, 151.35±76.12, 116.48±42.39, 33.61±11.82 (mg/dl) respectively. Conclusion-: In this study there is a non-significant positive association with high S. total cholesterol, high S. LDL-C, Low S. HDL-C but not with S. triglyceride. So, we can conclude that hyperlipidemia has weak association with VaD. Bangladesh Journal of Neuroscience 2016; Vol. 32 (1): 1-11

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孟加拉国一家三级医院卒中患者高脂血症与血管性痴呆的关系

背景:中风是老年人身体残疾的主要原因，也是痴呆症的第二大常见原因。在西方社会，阿尔茨海默氏症的患病率正在上升。但血管性痴呆(VaD)在孟加拉国和日本等发展中国家正在增加，原因是中风后死亡率下降和人口老龄化。相互矛盾的数据显示，高脂血症是缺血性中风的一个可改变的危险因素，与血管性痴呆的高风险相关。目的:本研究的目的是评估高脂血症与血管性痴呆的关系。方法:采用横断面描述性研究方法，于2014年8月- 2015年11月在达卡沙赫巴格邦班班杜谢赫穆吉布医科大学神经内科进行。所有18岁以上、在达卡Bangabandhu Sheikh Mujib医科大学神经内科就诊、卒中后至少3个月的卒中患者均为研究对象。在上述医院就诊并符合纳入和排除标准的患者采用有目的抽样技术选择病例。共评估73例。这些患者通过MMSE检查痴呆的证据。评估血管性痴呆的严重程度和危险因素。评估所有病例的空腹血脂水平，并评估其与VaD的关系。结果:本研究观察到卒中患者和VaD患者以5、6岁年龄组居多。脑卒中患者分别为17例(23.3%)和31例(42.5%)，VaD患者分别为10例(25.6%)和18例(46.6%)。男性多于女性(中风中男性占63%，女性占37%;VaD男性59%，女性41%)。本组73例患者中，吸烟者40例(54.8%)，高脂血症67例(91.8%)，高血压54例(74%)，糖尿病35例(47.9%)，IHD 15例(20.5%)，缺血性脑卒中64例(87.7%)，出血性脑卒中9例(12.3%)，卒中复发25例(34.25%)。大多数患者为家庭主妇16例(21.9%)，读至初级水平22例(30%)。73例脑卒中患者中39例(53.4%)有VaD。其中轻度痴呆12例(30.8%)，中度痴呆16例(41%)，重度痴呆11例(28.2%)。同样，39例VaD患者中有38例(97.4%)有缺血性卒中史，1例(2.6%)有中度痴呆的出血性卒中史。VaD和非血管性痴呆患者总胆固醇、甘油三酯、LDL-C和hdl - c的平均值分别为185.35±44.07、149.82±57.05、133.58±44.53、31.07±11.16 (mg/dl)和178.70±48.40、151.35±76.12、116.48±42.39、33.61±11.82 (mg/dl)。结论:在本研究中，高S.总胆固醇、高S. LDL-C、低S. HDL-C与S.甘油三酯无显著正相关。因此，我们可以得出结论，高脂血症与VaD的相关性较弱。孟加拉国神经科学杂志2016;Vol. 32 (1): 1-11

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Bangladesh Journal of Neuroscience

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