Background and Purpose:Cognitive impairment no dementia (CIND) and dementia are common stroke outcomes, with significant health and societal implications for aging populations. These outcomes are not included in current epidemiological models. We aimed to develop an epidemiological model to project incidence and prevalence of stroke, poststroke CIND and dementia, and life expectancy, in Ireland to 2035, informing policy and service planning.Methods:We developed a probabilistic Markov model (the StrokeCog model) applied to the Irish population aged 40 to 89 years to 2035. Data sources included official population and hospital-episode statistics, longitudinal cohort studies, and published estimates. Key assumptions were varied in sensitivity analysis. Results were externally validated against independent sources. The model tracks poststroke progression into health states characterized by no cognitive impairment, CIND, dementia, disability, stroke recurrence, and death.Results:We projected 69 051 people with prevalent stroke in Ireland in 2035 (22.0 per 1000 population [95% CI, 20.8–23.1]), with 25 274 (8.0 per 1000 population [95% CI, 7.1–9.0]) of those projected to have poststroke CIND, and 12 442 having poststroke dementia (4.0 per 1000 population [95% CI, 3.2–4.8]). We projected 8725 annual incident strokes in 2035 (2.8 per 1000 population [95% CI, 2.7–2.9]), with 3832 of these having CIND (1.2 per 1000 population [95% CI, 1.1–1.3]), and 1715 with dementia (0.5 per 1000 population [95% CI, 0.5–0.6]). Life expectancy for stroke survivors at age 50 was 23.4 years (95% CI, 22.3–24.5) for women and 20.7 (95% CI, 19.5–21.9) for men.Conclusions:This novel epidemiological model of stroke, poststroke CIND, and dementia draws on the best available evidence. Sensitivity analysis indicated that findings were robust to assumptions, and where there was uncertainty a conservative approach was taken. The StrokeCog model is a useful tool for service planning and cost-effectiveness analysis and is available for adaptation to other national contexts.

中文翻译：

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StrokeCog Markov 模型：预计到 2035 年爱尔兰中风和中风后认知障碍的流行和事件病例

背景和目的：认知障碍无痴呆 (CIND) 和痴呆是常见的中风结果，对老龄化人群具有重要的健康和社会影响。这些结果不包括在当前的流行病学模型中。我们的目标是开发一个流行病学模型来预测爱尔兰到 2035 年中风、中风后 CIND 和痴呆的发病率和患病率以及预期寿命，为政策和服务规划提供信息。方法：我们开发了一个概率马尔可夫模型（StrokeCog 模型）应用于到 2035 年 40 至 89 岁的爱尔兰人口。数据来源包括官方人口和医院发作统计数据、纵向队列研究和已发表的估计。敏感性分析中的关键假设各不相同。结果根据独立来源进行了外部验证。该模型跟踪卒中后进展到以无认知障碍、CIND、痴呆、残疾、卒中复发和死亡为特征的健康状态。结果：我们预计 2035 年爱尔兰有 69051 人患有普遍卒中（每 1000 人中有 22.0 人 [95% CI， 20.8–23.1]），其中 25 274 人（8.0/1000 人 [95% CI，7.1–9.0]）预计患有卒中后 CIND，12 442 人患有卒中后痴呆（4.0/1000 人 [95% CI，3.2– 4.8]）。我们预计 2035 年每年发生 8725 例卒中（每 1000 人 2.8 人 [95% CI，2.7-2.9]），其中 3832 人患有 CIND（每 1000 人 1.2 人 [95% CI，1.1-1.3]），1715 人患有痴呆（每 1000 人 0.5 [95% CI, 0.5–0.6]）。50 岁卒中幸存者的预期寿命为女性 23.4 岁（95% CI，22.3-24.5），男性为 20.7 岁（95% CI，19.5-21.9）。结论：这种新的中风、中风后 CIND 和痴呆的流行病学模型利用了现有的最佳证据。敏感性分析表明，调查结果对假设是稳健的，并且在存在不确定性的情况下采取了保守的方法。StrokeCog 模型是服务规划和成本效益分析的有用工具，可用于适应其他国家情况。