| ObjectiveStroke in China has the characteristics of high incidence,high disability rate,high mortality rate,high recurrence rate,and high economic burden,and the number of stroke patients ranks first in the world.Stroke can lead to many complications,such as functional disability,cognitive impairment,and mental and psychological diseases,which seriously affect the quality of life and survival time of patients and increase the incidence of dementia.Cognitive reserve refers to the ability of individuals to resist pathological damage and maintain optimal cognitive function accumulated from birth to onset of disease by engaging in various stimulating activities.Some studies have suggested that cognitive reserve is a protective factor of cognitive function and can moderate the relationship between brain pathological damage and cognitive performance.Cognitive reserve has been widely used in a variety of neurodegenerative diseases in Western countries,but there are few relevant studies on cognitive reserve in China,especially in patients with acute ischemic stroke(AIS).Therefore,this study aims to investigate the level of cognitive reserve and its relationship with cognitive function,physical function,depression and quality of life in patients with acute ischemic stroke.To explore the moderating effect of cognitive reserve on cognitive function in patients with acute ischemic stroke based on the simplified methodology model of stroke,and to screen the key population for cognitive intervention based on the moderating effect,so as to provide a basis for early cognitive intervention of stroke.MethodsGuided by the simplified methodology model for stroke,a cross-sectional study design was used.Eligible patients with acute ischemic stroke were selected from the stroke centers of 5 tertiary general hospitals in Shanghai and Nanjing.The demographic and sociological data,stroke-related data,cognitive reserve,cognitive function,physical function,depression and quality of life of the patients were investigated.Socio-demographic data included age,gender,years of education,marital status and type of household registration.Stroke risk factors include: The National Institutes of Health stroke scale(NIHSS)was used to assess the severity of stroke.Stroke was classified according to the Oxfordshire Community Stroke Project(OCSP)classification.The etiology was classified according to the TOAST(Trial of Org10172 in Acute Stroke Treatment)classification.The treatment methods include intravenous thrombolysis,arterial thrombectomy,conservative treatment,etc.The high risk factors of stroke included hypertension,diabetes,hyperlipidemia,atrial fibrillation,previous stroke history,large vessel stenosis,smoking history,drinking history,etc.Disease-related biochemical indicators and imaging indicators,etc.Cognitive Reserve Index questionnaire(CRIq)was used to evaluate the cognitive reserve level of patients.Montreal Cognitive Assessment(Mo CA-CS)was used to evaluate cognitive function.Barthel Index(BI)was used to evaluate the activities of daily living of patients.The modified Rankin Scale(m RS)was used to assess the functional disability of patients after stroke.ten-item Center for Epidemiologic Studies Depression Scale(CESD-10)was used to assess post-stroke depression.The Short Version of the Stroke Specific Quality of Life Scale(SV-SS-Qo L)was used to evaluate the quality of life of patients.SPSS26.0 statistical software was used to analyze the data.Socio-demographic data and stroke-related data of patients were descriptively analyzed.The t test /Wilcoxon rank sum test was used to compare the means of two independent samples.One-way analysis of variance(ANOVA)/Kruskal-Wallis H rank sum test was used to compare the means of multiple groups of measurement data.Multivariable linear regression(MLR)was used to analyze the relationship between cognitive function and stroke severity,cognitive reserve,stroke-related factors and socio-demographic factors.The moderating effect based on multiple regression was used to analyze the relationship between different cognitive reserve levels and cognitive function.Binary multivariate logistic regression was used to analyze the relationship between cognitive reserve and cognitive impairment.Results1.Sample collection : A total of 470 patients with acute ischemic stroke who met the criteria were included in this study.Three patients were excluded because they refused to cooperate with the investigation,and 7 patients were excluded because of incomplete data.2.Cognitive reserve level in patients with acute ischemic stroke : The average score of cognitive reserve in patients with acute ischemic stroke was(93.64±15.33),the average score of CRI-education was(101.61±15.72),the average score of CRI-occupation achievement was(100.37±15.64),and the average score of CRI-leisure activity was(83.41±11.95).Among them,the acute ischemic stroke patients with moderate cognitive reserve level were the most,accounting for 55.00%.3.Distribution characteristics of cognitive reserve in patients with acute ischemic stroke in different gender and age groups : The cognitive reserve level of male patients was significantly higher than that of female patients.In addition to CRI-leisure activities,CRI-education and CRI-occupation achievements showed significant gender differences(p < 0.05).The cognitive reserve of male and female patients in the same age group(≤54years old,55-64 years old,65-74 years old,≥75 years old)were compared.The results showed that there were gender differences in the total score of cognitive reserve,education score and occupation achievement score of patients in the 55-64 and 65-74 age groups.No statistical differences have been found in the total cognitive reserve score and composition of other age groups.4.Cognitive function,physical function,depression and quality of life : In this study,the average score of cognitive function(Mo CA)in patients with acute ischemic stroke was(20.99±7.01),and the patients with cognitive impairment(Mo CA < 27)accounted for 76.30%.19.13% of the patients had functional disability on admission(m RS3-5),and22.83% of the patients had functional disability before discharge(m RS3-5).The number of patients with physical dysfunction before discharge was more than that before admission.The average score of activities of daily living(BI)was(73.43±39.24),and the average score of quality of life(Qo L)was(40.46±11.58).The average score of depression in patients with acute ischemic stroke(CESD-10)was(6.87±5.19),and the patients with depression(CESD-10≥12)accounted for 19.35%.5.The relationship between cognitive reserve and cognitive function,physical function,depression and quality of life in patients with acute ischemic stroke.(1)The moderating effect of cognitive reserve on cognitive function in patients with acute ischemic stroke: the results showed that after controlling for sociodemographic and disease-related confounding factors,the interaction term between NIHSS score at admission and cognitive reserve was statistically significant(β=-0.01,p<0.001),indicating that cognitive reserve played a positive moderator between stroke severity and cognitive function.In addition,cognitive function in patients with acute ischemic stroke was significantly negatively correlated with stroke severity,age,diabetes,and depression(p < 0.05),and was significantly positively correlated with cognitive reserve(p < 0.001).Cognitive function in patients with acute ischemic stroke was also significantly correlated with Oxfordshire Community Stroke Project Classification(OCSP classification)(p < 0.05).(2)The effect of cognitive reserve on cognitive function in patients with different severity of stroke: after controlling for stroke severity,age,diabetes,depression and stroke type,the cognitive function of patients with moderate cognitive reserve level was significantly higher than that of patients with low cognitive reserve level(β=2.36,p <0.001),and the cognitive function of patients with high cognitive reserve level was significantly higher than that of patients with low cognitive reserve level(β=4.00,p <0.001).That is,in patients with mild and moderate stroke,the higher the level of cognitive reserve,the better the cognitive function.When the severity of acute ischemic stroke reaches a certain level(NIHSS > 13),the higher the level of cognitive reserve,the worse the cognitive function after stroke.(3)The correlation between cognitive reserve and cognitive impairment in patients with acute ischemic stroke: after controlling for the effects of demographic and disease-related factors(NIHSS score at admission,OCSP classification,diabetes,drinking,and depression)on post-stroke cognitive impairment,cognitive reserve was a protective factor for post-stroke cognitive impairment(p < 0.05).Acute ischemic stroke patients with high cognitive reserve level were 0.21 times more likely to have cognitive impairment than those with low cognitive reserve level(95%CI=0.08-0.53).Acute ischemic stroke patients with moderate cognitive reserve level were 0.35 times more likely to develop cognitive impairment than those with low cognitive reserve level(95%CI = 0.20-0.63).(4)The relationship between cognitive reserve and physical function,depression,and quality of life: our study explored the relationship between cognitive reserve and physical function(activities of daily living and functional disability),depression and quality of life in patients with acute ischemic stroke,and the results showed no statistically significant differences(p > 0.05).Conclusion1、In our study,cognitive reserve of patients with acute ischemic stroke was at a medium level,and the patients with high cognitive reserve level were the least.2、The level of cognitive reserve of male patients was significantly higher than that of female patients,especially in the scores of education and occupation achievement of cognitive reserve,while there was no gender difference in the scores of leisure activities of cognitive reserve.The cognitive reserve scores of different age groups were different in different countries,regions and historical and cultural backgrounds.The cognitive reserve scores of the elderly in developing countries were slightly higher than those of the young,while the Western countries were the opposite.There is no gender difference in cognitive reserve leisure activities among the elderly in many studies,which may be related to the decline of physical function and social participation in the elderly.3、After adjusting for socio-demographic and disease-related factors,cognitive reserve had a moderate effect on cognitive function in patients with acute ischemic stroke.In patients with mild to moderate stroke,the higher the level of cognitive reserve,the better the cognitive function.However,when the severity of stroke reaches a certain level,the higher the level of cognitive reserve,the worse the cognitive function.4、Cognitive reserve is a protective factor for cognitive function in patients with acute ischemic stroke. |
PDF Full Text Request