卒中患病时间对老年人群认知功能的影响

Effect of stroke duration on the cognitive function in the elderly population

目的分析卒中患病时间对北京市老年人群认知功能的影响。方法基于北京市慢病合并常见老年综合征社区管理规范研究课题,采用横断面研究方法,自2013年7月至2014年12月通过多阶段、随机、分层的抽样方法对北京市4个区县(西城区、房山区、通州区、延庆县)的老年人群进行抽样,共纳入研究对象3 024名。采用问卷调查和临床检查获取数据,以简易精神状态检查量表(MMSE)评分为认知功能的评价指标,依据MMSE量表评分情况,将研究对象分为认知功能正常组(MMSE>26分,1 878名)和认知功能障碍组(MMSE≤26分,1 146例)。采用多因素Logistic回归模型分析出血性卒中、缺血性卒中及无症状卒中的患病情况及患病时间对认知功能的影响。结果经校正性别、年龄、受教育程度、婚姻、吸烟、饮酒等混杂因素后,患病1~3年、4~1 0年、>1 0年的出血性卒中患者发生认知功能障碍的风险分别为未发生卒中人群的3.019(95%CI:0.974~9.361,P=0.056)、8.652(95%CI:2.924~25.601,P<0.01)、1.104倍(95%CI:0.311~3.920,P=0.879);患病1~3年、4~10年、>10年的缺血性卒中患者发生认知功能障碍的风险分别为未发生卒中人群的1.000(95%CI:0.636~1.571,P=1.000)、1.874(95%CI:1.231~2.853,P=0.003)、2.439倍(95%CI:1.386~4.291,P=0.002)。出血性卒中患者患病4~10年及缺血性卒中患者患病4~10年、>10年均为认知功能障碍发生的危险因素。结论对于卒中患者,卒中患病时间或长期效应对认知功能有一定影响。

Objective To analyze the effect of stroke duration on the cognitive function in the elderly population in Beijing. Methods Based on the Research Project of Beijing Chronic Disease Combined with Common Elderly Syndrome Community Management Practices,a cross-sectional study was used. From July 2013 to December 2014,the old population in 4 districts and a county（ Xicheng District,Fangshan District,Tongzhou District and Yanqing County） in Beijing were sampled with the multi-stage,randomized and stratified sampling. A total of 3 024 subjects were enrolled in the study. The data were obtained from the questionnaires and clinical examinations. Mini-Mental State Examination（ MMSE） was used as the evaluation index of cognitive function. The subjects were divided into either a normal cognitive function group（ MMSE 26,n = 1 878） or a cognitive impairment group（ MMSE≤26,n = 1 146） according to the MMSE scores. A multiple logistic regression model was used to analyze the effects of hemorrhagic stroke,ischemic stroke,and asymptomatic stroke,as well as disease duration on cognitive function. Results After adjusting for the confounding factors,such as sex,age,educational level,marriage,smoking,and alcohol consumption,the risks of occurring cognitive impairment in patients with hemorrhagic stroke in stroke duration for 1-3,4-10 and 10 years were OR 3. 019（ 95% CI 0. 974-9. 361,P = 0. 056）,8. 652（ 95% CI 2. 924-25. 601,P〈0. 01） and 1. 104（ 95% CI 0. 311-3. 920,P = 0. 879） times of those without occurring stroke population;the risks of occurring cognitive impairment in patients with ischemic stroke in stroke duration for 1-3,4-10 and 10 years were 1. 000（ 95% CI 0. 636-1. 571,P = 1. 000）,1. 874（ 95% CI 1. 231-2. 853,P =0. 003）,2. 439（ 95% CI 1. 386-4. 291,P = 0. 002） times of those without occurring stroke population.Stroke duration for 4-10 years in patients with hemorrhagic stroke and stroke duration for 4-10 and 10 years in patients with ischemic stroke were all the risk factors for occurring cognitive dysfunction.Conclusion For patients with stroke,stroke duration or long-term effects has a certain impact on cognitive function.