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Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging-Detected Vascular Brain Injury.
Stroke ( IF 7.8 ) Pub Date : 2020-03-04 , DOI: 10.1161/strokeaha.119.028179
Sonia S Anand 1, 2, 3 , Matthias G Friedrich 4 , Dipika Desai 3 , Karleen M Schulze 1, 3 , Philip Awadalla 5 , David Busseuil 6 , Trevor J B Dummer 7 , Sébastien Jacquemont 8 , Alexander Dick 9 , David Kelton 10 , Anish Kirpalani 11 , Scott A Lear 12 , Jonathan Leipsic 13 , Michael D Noseworthy 14 , Louise Parker 15 , Grace Parraga 16 , Paul Poirier 17 , Paula Robson 18 , Jean-Claude Tardif 6 , Koon Teo 1, 2, 3 , Jennifer Vena 19 , Salim Yusuf 1, 2, 3 , Alan R Moody 20 , Sandra E Black 20, 21 , Eric E Smith 22 ,
Affiliation  

Background and Purpose- Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods- Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results- The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (P<0.0001), INTERHEART risk score (P<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, -1.3 to -0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, -3.2 to -0.6) per high white matter hyperintensities, 3.5 (95% CI, -6.4 to -0.7) per nonlacunar stroke, and 6.8 (95% CI, -11.5 to -2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12-17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8-30), and MRI vascular brain injury accounted for 10% (95% CI, -3 to 22) of low test scores. Conclusions- Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.

中文翻译:

磁共振成像检测到的血管性脑损伤患者的认知评估得分降低。

背景和目的-关于中年人群隐性血管性脑损伤与认知障碍之间的关系知之甚少。我们调查了心血管疾病风险较高的人和隐性血管性脑损伤的人在认知筛查上的得分是否较低。方法-使用数字符号替代测试和蒙特利尔认知评估以及磁共振成像(MRI)技术对无心血管疾病的757名成年人(年龄在35至69岁之间)进行了认知评估,以检测隐性血管性脑损伤(白质过高,腔隙性和非腔隙性脑梗死)。使用INTERHEART(急性心肌梗塞危险因素全球研究)危险评分对心血管危险因素进行量化。多变量混合模型测试了降低认知得分的独立决定因素。计算低认知得分的人群归因风险因素和MRI血管性脑损伤风险。结果-参与者的平均年龄为58(SD,9)岁;55%为女性。蒙特利尔认知评估和数字符号替代测试得分随着年龄的增长(P <0.0001),INTERHEART风险得分(P <0.0001)以及高白质高信号,非腔隙性脑梗死和3例无声脑梗死的个体而显着降低。经年龄,性别,教育程度,种族协变量调整后,数字符号替代测试每5分心血管风险得分增加1.9(95%CI,-3.2至0.9)就显着降低了1.0(95%CI,-1.3至-0.7)点。 -0。6)出现高白质高信号时,如果出现3个以上无声脑梗塞,则每个非腔隙性卒中分别为3.5(95%CI,-6.4至-0.7)和6.8(95%CI,-11.5至-2.2)。没有大专学历的占15%(95%CI,12-17),中,高水平的心血管危险因素占19%(95%CI,8-30),MRI血管性脑损伤占10%(95) %CI,-3至22)的低测试分数。结论-在中年社区居民中,具有较高心血管危险因素或MRI血管性脑损伤的个体的认知筛查分数较低。低认知得分的人群归因风险可归因于较低的教育程度,较高的心血管危险因素和MRI血管性脑损伤。5至-2.2),当出现3+个无声脑梗塞时。没有大专学历的占15%(95%CI,12-17),中,高水平的心血管危险因素占19%(95%CI,8-30),MRI血管性脑损伤占10%(95) %CI,-3至22)的低测试分数。结论-在中年社区居民中,具有较高心血管危险因素或MRI血管性脑损伤的个体的认知筛查分数较低。低认知得分的人群归因风险可归因于较低的教育程度,较高的心血管危险因素和MRI血管性脑损伤。5至-2.2),当出现3+个无声脑梗塞时。没有大专学历的占15%(95%CI,12-17),中,高水平的心血管危险因素占19%(95%CI,8-30),MRI血管性脑损伤占10%(95) %CI,-3至22)的低测试分数。结论-在中年社区居民中,具有较高心血管危险因素或MRI血管性脑损伤的个体的认知筛查分数较低。低认知得分的人群归因风险可归因于较低的教育程度,较高的心血管危险因素和MRI血管性脑损伤。中低水平的心血管危险因素占低测试分数的19%(95%CI,8-30),而MRI血管性脑损伤占10%(95%CI,-3至22)。结论-在中年社区居民中,具有较高心血管危险因素或MRI血管性脑损伤的个体的认知筛查分数较低。低认知得分的人群归因风险可归因于较低的教育程度,较高的心血管危险因素和MRI血管性脑损伤。中低水平的心血管危险因素占低测试分数的19%(95%CI,8-30),而MRI血管性脑损伤占10%(95%CI,-3至22)。结论-在中年社区居民中,具有较高心血管危险因素或MRI血管性脑损伤的个体的认知筛查分数较低。低认知得分的人群归因风险可归因于较低的教育程度,较高的心血管危险因素和MRI血管性脑损伤。
更新日期:2020-03-04
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