缺血性脑卒中后认知的改变。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Wenci Yan, Terence Quinn, Alex McConnachie, Niall Broomfield, Yun Wong, David Dickie, Kirsten Forbes, Matthew Walters, Jesse Dawson
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引用次数: 0

摘要

目的:缺血性脑卒中可导致认知能力下降。认知如何随着时间的推移而变化,以及认知变化与认知变化的关系,人们知之甚少。本研究旨在探讨缺血性卒中后2年内的这些问题。方法:本分析使用来自XILO-FIST研究的数据,这是一项根据基于组织的定义在缺血性卒中患者中使用别嘌呤醇与安慰剂的临床试验。参与者在基线时进行临床评估,脑MRI,基线时进行蒙特利尔认知评估(MoCA),第1年和第2年。我们将认知障碍定义为MoCA评分。结果:360名具有完整MoCA数据的参与者被纳入研究。平均年龄65.4岁(SD 8.36),平均MoCA基线评分26.4 (SD 2.7)。77名参与者在第二年的认知能力有所提高。84人在第二年出现认知能力下降。在调整了年龄和受教育年限后,第二年认知能力的改善与脑容量变小、白蛋白水平降低、吸烟和白质高强度相关,第二年认知能力的下降与外周动脉疾病、高胆固醇水平、小血管中风和白质高强度相关。解释:中风后认知是动态的,有不同的变化模式。脑储备和血管危险因素与脑卒中后认知改变有关。这种认知轨迹的复杂性对中风后的认知康复提供和认知障碍检测具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Change in Cognition Following Ischaemic Stroke.

Objective: Cognitive decline can occur following ischaemic stroke. How cognition changes over time and associations with cognitive change are poorly understood. This study aimed to explore these issues over 2 years following ischaemic stroke.

Methods: This analysis used data from the XILO-FIST study, a clinical trial of allopurinol versus placebo in people with ischaemic stroke according to Tissue-Based Definition. Participants underwent clinical assessment, brain MRI at baseline, and Montreal Cognitive Assessment (MoCA) at baseline, year 1 and year 2. We defined cognitive impairment as a MoCA score < 26 and cognitive change as a difference in MoCA score of 2 points or more at year 1 or year 2 after randomisation. Associations with cognitive impairment and cognitive change were assessed by univariable analysis and multiple logistic regression.

Results: Three hundred and sixty participants with complete MoCA data were included. Mean age was 65.4 (SD 8.36) years, and mean baseline MoCA score was 26.4 (SD 2.7). Seventy-seven participants had second-year cognitive improvement. Eighty-four had second-year cognitive decline. After adjustment for age and education year, second-year cognitive improvement was associated with smaller brain volume, lower albumin level, smoking and greater white-matter hyperintensity, and second-year cognitive decline was associated with peripheral arterial disease, higher cholesterol level, small-vessel stroke and greater white-matter hyperintensity.

Interpretation: Cognition is dynamic following stroke, with different patterns of change. Brain reserve and vascular risk factors relate to later post-stroke cognitive change. This complex nature of cognitive trajectory has implications for cognitive rehabilitation provision and cognitive impairment detection after stroke.

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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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