| Background and Purpose: Ischemic stroke is a common neurological disease, which has the characteristics of high incidence and high morbidity, a serious threat to the elderly, the care and economic burden to families and society enormous. About 10% to 13% of patients admitted to the hospital after an acute stroke have pre-existing dementia. While about 20% to 30% of patients with acute ischemic stroke cognitive impairment, known as cognitive impairment after stroke. The purpose of this study is to determine the prevalence of acute ischemic pre-stroke dementia and the incidence of acute ischemic post-stroke cognitive impairment and the factors associated with them and clinical outcome.Methods: Subjects for this study were recruited from among acute ischemic stroke patients admitted consecutively to the hospital from August 2013 to December 2014.Patients with IQCODE≥104 were classified as having pre-stroke dementia, and<104 were classified as without dementia. The patients were divided into either a cognitive impairment group(scores of MMSE, illiteracy≤19 points; primary≤22 points; junior high school and above≤26 points, and CDR≥0.5) or a non-cognitive impairment group according to the MMSE scores. Demographics, vascular risk factors, image data, and biochemical results were collected. The research assistant administered the m RS three months later by phone, letter or home visits, access to relapse, disability and death in patients, and follow-up according to m RS scores were divided into two groups: favorable outcome group(m RS score 0-2) and unfavorable outcome group(m RS score 3-5, and death). Factors between patients with and without pre-stroke dementia, with and without post-stroke cognitive impairment, and favorable outcome group and unfavorable outcome group were univariate analysis and Logistic regression analysis, and determined the prevalence of acute ischemic pre-stroke dementia and the incidence of acute ischemic post-stroke cognitive impairment and the factors associated with them and clinical outcome.Results: Continuity 322 cases were collected, of which 69 cases do not meet the inclusion criteria(61 patients time of onset>14 days, 8 patients aged <40 years); exclude 35 cases(18 patients transient ischemic attack, 12 patients with malignant tumors or 5 patients renal failure); 28 cases of incomplete information. A total of 190 cases included in the study, 121 patients were male, 69 cases of female patients, aged 41-90 years, mean 62±11 years.There are 26 cases(13.7%) had pre-stroke dementia, 45 cases(27.4%) had post-stroke cognitive impairment. Univariate analysis of pre-stroke dementia group were older than those without pre-stroke dementia group, pre-stroke dementia group had previous stroke is more than without pre-stroke dementia group, pre-stroke dementia group had TACI of OCSP more than without pre-stroke dementia group, NIHSS score of pre-stroke dementia group higher than without pre-stroke dementia group, pre-stroke dementia group had subcortical infarcts more than without pre-stroke dementia group, the number of old infarcts of pre-stroke dementia group more than without pre-stroke dementia group, the scores of WML of pre-stroke dementia group higher than without pre-stroke dementia group, HI, FHI, TVW, PLT, LDL, TC in pre-stroke dementia group higher than without pre-stroke dementia group, the difference was statistically significant(P<0.05). Multivariate analysis of the independent risk factors for pre-stroke dementia is previous stroke(OR 7.764, 95% CI 2.394-25.177) and LDL(OR 2.420, 95% CI 1.274-4.597). Univariate analysis of the age of unfavorable clinical outcome group older than favorable clinical outcome group, the level education of unfavorable clinical outcome lower than favorable clinical outcome group, NIHSS score higher than favorable clinical outcome group, TOAST classification LAA ratio is higher than favorable clinical outcome group, OCSP classification TACI ratio is higher than favorable clinical outcome group, unfavorable clinical outcome group had PSD more than favorable clinical outcome group, the difference was statistically significant(P<0.05).Multivariate analysis of the independent risk factors for clinical outcome is educational(OR 5.978, 95% CI 1.439-24.836), NIHSS score(OR 3.436, 95% CI 1.448-8.149) and PSD(OR 1.358, 95% CI 1.308-1.597).Univariate analyzes of post-stroke cognitive impairment group had hyperlipidemia more than without post-stroke cognitive impairment group, post-stroke cognitive impairment group had previous stroke more than without post-stroke cognitive cognitive impairment group, post-stroke cognitive impairment group had patients smoking more than without post-stroke cognitive impairment group, the scores of WML of post-stroke cognitive impairment group higher than without post-stroke cognitive impairment group, FHI in post-stroke cognitive impairment group higher than without post-stroke cognitive impairment group, the differences are statistically significant(P<0.05). Multivariate analysis of the independent risk factors for post-stroke cognitive impairment is previous stroke(OR 3.367, 95% CI 1.423-7.975) and FHI(OR 2.433, 95% CI 1.026-5.771). Univariate analysis of the age of unfavorable clinical outcome group older than favorable clinical outcome group, the level education of unfavorable clinical outcome lower than favorable clinical outcome group, NIHSS score higher than favorable clinical outcome group, OCSP classification TACI high ratio in the favorable clinical outcome group, the scores of TG, FIB, HI and FH of unfavorable clinical outcome group higher than favorable clinical outcome group, unfavorable clinical outcome group had PSCI more than favorable clinical outcome group, the difference was statistically significant(P<0.05).Multivariate analysis of the independent risk factors for clinical outcome is WML(OR 5.103, 95% CI 1.424-18.279) and PSCI(OR 1.136, 95% CI 1.305-1.924).Conclusion: This study showed that the prevalence of pre-stroke dementia is 13.7%, history of stroke and high LDL levels are an independent risk factor of pre-stroke dementia. The incidence of post-stroke cognitive impairment was 27.4%, a history of stroke, high LDL levels and frontal atrophy is an independent risk factor of post-stroke cognitive impairment. PSD and PSCI was an independent risk factor for clinical outcome. |
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