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Ischemic Heart Disease and Cognitive Prognosis in the First Year after Stroke
medRxiv - Neurology Pub Date : 2020-05-22 , DOI: 10.1101/2020.05.18.20106088
Michael J O'Sullivan , Paul Wright

Importance: Cognitive impairment is the greatest single source of unmet need identified by stroke survivors. Knowledge of the factors that influence cognitive prognosis will lead to better preventive and rehabilitation strategies. Objective: To identify the factors that influence general cognitive function, memory and executive function in the first year after ischemic stroke. Design: Single centre longitudinal observational study. Setting: Hospital stroke service. Participants: A cohort of 179 patients identified within 7 days of first symptomatic ischaemic stroke were enrolled into a longitudinal cognitive study, STRATEGIC. General cognitive function, episodic memory and executive function were assessed in the first three months and again at one year after stroke. Lesion topography was defined by imaging (n=152) performed in the acute period. Cognitive evaluation was repeated at one year in 141 participants. Main Outcome Measures: Montreal Cognitive Assessment (MoCA) score at 1 year. Verbal free recall (Free and Cued Selective Reminding Test) and Digit Symbol Substitution Score provided secondary outcome measures of episodic memory and executive function respectively. Results: At 50+-19 days after stroke, diabetes mellitus and smoking were associated with MoCA score independent of other risk and demographic factors. Lesion vascular territory was independently associated with memory while white matter lesion burden was associated with executive function. In contrast to other risk factors, ischaemic heart disease was associated with change in cognitive scores and MoCA score at one year but not MoCA score at 3 months. IHD was the only factor significantly associated with change over time. This association was significant independent of other factors. Conclusions and Relevance: Associations between post-stroke cognition, and age, diabetes, smoking and white matter lesions, are likely to reflect the general effects of these factors on brain structure and function. These risk factors are not associated with change in cognitive function between 3 months and one year. In contrast, pre-existing ischemic heart disease was associated specifically with change in cognition over time. On average, patients with IHD showed decline in MoCA scores between 3 and 12 months while those free of IHD showed improvement. Intervention for IHD, alongside best-care stroke rehabilitation, merits investigation as a strategy to improve cognitive prognosis after stroke.

中文翻译:

中风后第一年的缺血性心脏病和认知预后

重要性:认知障碍是中风幸存者发现的未满足需求的最大单一来源。了解影响认知预后的因素将导致更好的预防和康复策略。目的:确定缺血性卒中后第一年影响一般认知功能,记忆和执行功能的因素。设计:单中心纵向观察研究。地点:医院中风服务。参与者:在首次有症状的缺血性中风的7天内发现的179名患者纳入了纵向认知研究STRATEGIC。在卒中后的头三个月和一年后再次评估一般认知功能,情景记忆和执行功能。通过在急性期进行的影像学检查(n = 152)确定病变的地形。141名参与者在一年内重复进行了认知评估。主要指标:蒙特利尔认知评估(MoCA)评分为1年。言语自由回忆(自由和暗示选择性提醒测试)和数字符号替代分数分别提供了情景记忆和执行功能的次要结果。结果:中风后50 + -19天,糖尿病和吸烟与MoCA评分相关,而与其他风险和人口统计学因素无关。病变血管区域与记忆独立相关,而白质病变负担与执行功能相关。与其他危险因素相反,缺血性心脏病与一年后认知评分和MoCA评分的变化相关,而与3个月时MoCA评分无关。IHD是与时间变化显着相关的唯一因素。该关联显着独立于其他因素。结论和相关性:脑卒中后认知与年龄,糖尿病,吸烟和白质损害之间的相关性可能反映了这些因素对脑结构和功能的一般影响。这些危险因素与3个月至一年之间的认知功能变化无关。相反,先前存在的缺血性心脏病与认知随时间的变化特别相关。平均而言,患有IHD的患者在3到12个月内MoCA评分下降,而没有IHD的患者则表现出改善。对IHD的干预以及最佳的卒中康复治疗,应将调查作为改善卒中后认知预后的一项策略。脑卒中后认知与年龄,糖尿病,吸烟和白质损害之间的关联性很可能反映出这些因素对大脑结构和功能的总体影响。这些危险因素与3个月至一年之间的认知功能变化无关。相反,先前存在的缺血性心脏病与认知随时间的变化特别相关。平均而言,患有IHD的患者在3到12个月内MoCA评分下降,而没有IHD的患者则有所改善。对IHD的干预以及最佳的卒中康复治疗,应将调查作为改善卒中后认知预后的策略。脑卒中后认知与年龄,糖尿病,吸烟和白质损害之间的关联可能反映了这些因素对脑结构和功能的一般影响。这些危险因素与3个月至一年之间的认知功能变化无关。相反,先前存在的缺血性心脏病与认知随时间的变化特别相关。平均而言,患有IHD的患者的MoCA评分在3到12个月之间下降,而没有IHD的患者的MoCA评分有所改善。对IHD的干预以及最佳护理的中风康复,应将调查作为改善中风后认知预后的策略。可能反映了这些因素对大脑结构和功能的一般影响。这些危险因素与3个月至一年之间的认知功能变化无关。相反,先前存在的缺血性心脏病与认知随时间的变化特别相关。平均而言,患有IHD的患者的MoCA评分在3到12个月之间下降,而没有IHD的患者的MoCA评分有所改善。对IHD的干预以及最佳护理的中风康复,应将调查作为改善中风后认知预后的策略。可能反映了这些因素对大脑结构和功能的一般影响。这些危险因素与3个月至一年之间的认知功能变化无关。相反,先前存在的缺血性心脏病与认知随时间的变化特别相关。平均而言,患有IHD的患者的MoCA评分在3到12个月之间下降,而没有IHD的患者的MoCA评分有所改善。对IHD的干预以及最佳护理的中风康复,应将调查作为改善中风后认知预后的策略。IHD患者的MoCA评分在3到12个月之间下降,而IHD患者的MoCA评分则有所改善。对IHD的干预以及最佳护理的中风康复,应将调查作为改善中风后认知预后的策略。IHD患者的MoCA评分在3到12个月之间下降,而IHD患者的MoCA评分则有所改善。对IHD的干预以及最佳护理的中风康复,应将调查作为改善中风后认知预后的策略。
更新日期:2020-05-22
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