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Factors Associated with Cognitive Outcomes After First-Ever Ischemic Stroke: The Impact of Small Vessel Disease Burden and Neurodegeneration
Journal of Alzheimer’s Disease ( IF 4 ) Pub Date : 2021-09-14 , DOI: 10.3233/jad-210587
Pi-Shan Sung, Kang-Po Lee, Po-Yu Lin, Hui-Chen Su, Rwei-Ling Yu, Kuen-Jer Tsai, Sheng-Hsiang Lin, Chih-Hung Chen

Background:Differences exist regarding post-stroke cognitive outcomes. Objective:The aim of this study investigates the potential factors associated with post-stroke cognitive performance and trajectories. Methods:We performed a prospective cohort study using serial monitoring of cognitive functionover a 1-year period after a first-ever ischemic stroke. Small vessel disease (SVD) burden and hippocampal atrophy (HA) were evaluated using the modified cerebral small vessel disease scores (mCSVD) and medial temporal atrophy score (MTA) scores. A generalized estimating equation (GEE) model and a group-based trajectory model (GBTM) was used to analyze the potential factors associated with post-stroke cognitive outcomes. Results:A total of 112 patients were enrolled. The GEE model showed that all patients, regardless of initial cognitive performance, had a tendency to show an increase in the Montreal Cognitive Assessment over time. The cognitive performance was better in male patients with higher education levels (p = 0.046 and p < 0.001, respectively), but tended to be worse in patients with higher SVD burden and HA. The GBTM model grouped patients into low, intermediate, and high performance (LP, IP, and HP) after stroke. A higher SVD burden, rather than HA and initial stroke severity and location, independently predicted a higher odds of poor post-stroke cognitive trajectory (being in the LP group) after stroke (adjusted odds ratio 2.74, 95%CI 1.09–6.86). Conclusion:In patients with first-ever mild stroke, cognitive improvement over time was evident. The detrimental impact of the SVD burden may outweigh the effect of HA or acute stroke insult on the post-stroke cognitive trajectory during the 1-year follow-up.

中文翻译:

与首次缺血性中风后认知结果相关的因素:小血管疾病负担和神经变性的影响

背景:中风后认知结果存在差异。目的:本研究的目的是调查与卒中后认知表现和轨迹相关的潜在因素。方法:我们进行了一项前瞻性队列研究,在首次缺血性中风后的 1 年内连续监测认知功能。使用改良的脑小血管疾病评分 (mCSVD) 和内侧颞侧萎缩评分 (MTA) 评分评估小血管疾病 (SVD) 负担和海马萎缩 (HA)。使用广义估计方程 (GEE) 模型和基于组的轨迹模型 (GBTM) 来分析与卒中后认知结果相关的潜在因素。结果:共纳入112例患者。GEE 模型显示,所有患者,无论最初的认知表现如何,随着时间的推移,蒙特利尔认知评估有增加的趋势。受教育程度较高的男性患者的认知表现较好(分别为 p = 0.046 和 p < 0.001),但在 SVD 负担和 HA 较高的患者中往往较差。GBTM 模型将中风后患者分为低、中和高性能(LP、IP 和 HP)。较高的 SVD 负担,而不是 HA 和初始卒中严重程度和位置,独立预测卒中后较差的卒中后认知轨迹(处于 LP 组)的可能性较高(调整后的比值比为 2.74,95%CI 为 1.09-6.86)。结论:在首次轻度中风患者中,随着时间的推移,认知改善是明显的。
更新日期:2021-09-15
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