中国卒中杂志 ›› 2023, Vol. 18 ›› Issue (01): 68-75.DOI: 10.3969/j.issn.1673-5765.2023.01.006
吴雅婷, 魏宸铭, 武剑
收稿日期:
2022-11-01
出版日期:
2023-01-20
发布日期:
2023-01-20
通讯作者:
武剑 wujianxuanwu@126.com
基金资助:
清华大学精准医学科研计划(10001020128; 10001020104)
首都卫生发展科研专项 (首发2020-1-2241)
北京市医院管理局临床医学发展专项(XMLX202140)
北京市高层次公共卫生技术人才建设培养领军人才项目(2022-1-006)
国家自然科学基金项目 (82271324)
Received:
2022-11-01
Online:
2023-01-20
Published:
2023-01-20
摘要: 卒中后认知障碍为卒中的常见并发症之一,可严重影响卒中患者的生活质量及预后。目前认为血压与卒中后认知障碍密切相关,血压可能对卒中后认知障碍的主要病理生理过程产生潜在影响,并且控制血压可能有助于卒中后认知障碍的改善或预防。血压与卒中后认知障碍之间的相关性较为复杂,可能取决于特定的血压参数和卒中的不同阶段。目前卒中后的最佳血压控制水平尚不统一。本文对卒中后认知障碍的流行病学,血压与卒中后认知障碍的相关性,血压影响卒中后认知障碍的相关机制,以及控制血压的作用进行综述,为进一步阐明卒中后认知障碍的病理生理过程提供重要依据,以期有助于指导临床治疗,从而改善卒中患者的预后。
吴雅婷, 魏宸铭, 武剑. 卒中患者血压水平与卒中后认知障碍关系的研究进展[J]. 中国卒中杂志, 2023, 18(01): 68-75.
WU Yating, WEI Chenming, WU Jian. Progress of Blood Pressure and Post-stroke Cognitive Impairment[J]. Chinese Journal of Stroke, 2023, 18(01): 68-75.
[1] MADUREIRA S,GUERREIRO M,FERRO J M. Dementia and cognitive impairment three months after stroke[J]. Eur J Neurol,2001,8(6):621-627. [2] LIN J H,LIN R T,TAI C T,et al. Prediction of poststroke dementia[J]. Neurology,2003,61(3):343-348. [3] PENDLEBURY S T,ROTHWELL P M. Prevalence,incidence,and factors associated with pre-stroke and post-stroke dementia:a systematic review and meta-analysis[J]. Lancet Neurol,2009,8(11):1006-1018. [4] MAKIN S D,TURPIN S,DENNIS M S,et al. Cognitive impairment after lacunar stroke:systematic review and meta-analysis of incidence,prevalence and comparison with other stroke subtypes[J]. J Neurol Neurosurg Psychiatry,2013,84(8):893-900. [5] QU Y J,ZHUO L,LI N,et al. Prevalence of post-stroke cognitive impairment in China:a community-based,cross-sectional study[J/OL]. PLoS One,2015,10(4):e0122864[2022-10-25]. https://doi.org/10.1371/journal.pone.0122864. [6] GAO C Y,LIAN Y,ZHANG M,et al. Association of dementia with death after ischemic stroke:a two-year prospective study[J]. Exp Ther Med,2016,12(3):1765-1769. [7] KIVIPELTO M,HELKALA E L,LAAKSO M P,et al. Midlife vascular risk factors and alzheimer’s disease in later life: longitudinal,population based study[J]. BMJ,2001,322(7300):1447-1451. [8] MA Y,WOLTERS F J,CHIBNIK L B,et al. Variation in blood pressure and long-term risk of dementia:a population-based cohort study[J/OL]. PLoS Med,2019,16(11):e1002933[2022-10-25]. https://doi.org/10.1371/journal.pmed.1002933. [9] MATSUMOTO A,SATOH M,KIKUYA M,et al. Day-to-day variability in home blood pressure is associated with cognitive decline:the Ohasama study[J]. Hypertension,2014,63(6):1333-1338. [10] KALARIA R N,AKINYEMI R,IHARA M. Stroke injury,cognitive impairment and vascular dementia[J]. Biochim Biophys Acta,2016,1862(5):915-925. [11] 汪凯,董强. 卒中后认知障碍管理专家共识2021[J]. 中国卒中杂志,2021,16(4):376-389. [12] RIST P M,CHALMERS J,ARIMA H,et al. Baseline cognitive function,recurrent stroke,and risk of dementia in patients with stroke[J]. Stroke,2013,44(7):1790-1795. [13] NYS G M,VAN ZANDVOORT M J,DE KORT P L,et al. Restrictions of the mini-mental state examination in acute stroke[J]. Arch Clin Neuropsychol,2005,20(5):623-629. [14] SUN J H,TAN L,YU J T. Post-stroke cognitive impairment:epidemiology,mechanisms and management[J/OL]. Ann Transl Med,2014,2(8):80[2022-10-25]. https://doi.org/10.3978/j.issn.2305-5839.2014.08.05. [15] ZHOU H D,WANG Y J,LI J C,et al. Frequency and risk factors of vascular cognitive impairment three months after ischemic stroke in China:the Chongqing stroke study[J]. Neuroepidemiology,2005,24(1/2):87-95. [16] GENG S,LIU N,MENG P,et al. Midterm blood pressure variability is associated with poststroke cognitive impairment:a prospective cohort study[J/OL]. Front Neurol,2017,8:365[2022-10-25]. https://doi.org/10.3389/fneur.2017.00365. [17] OH H,PARK J,SEO W. A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment[J/OL]. Int J Nurs Pract,2018,24(2):e12618[2022-10-25]. https://doi.org/10.1111/ijn.12618. [18] ZHU Y L,ZHAO S,FAN Z Q,et al. Evaluation of the mini-mental state examination and the montreal cognitive assessment for predicting post-stroke cognitive impairment during the acute phase in Chinese minor stroke patients[J/OL]. Front Aging Neurosci,2020,12:236[2022-10-25]. https://doi.org/10.3389/fnagi.2020.00236. [19] MOK V C,LAM B Y,WONG A,et al. Early-onset and delayed-onset poststroke dementia-revisiting the mechanisms[J]. Nat Rev Neurol,2017,13(3):148-159. [20] DESMOND D W,MORONEY J T,PAIK M C,et al. Frequency and clinical determinants of dementia after ischemic stroke[J]. Neurology,2000,54(5):1124-1131. [21] YANG J,WONG A,WANG Z L,et al. Risk factors for incident dementia after stroke and transient ischemic attack[J]. Alzheimers Dement,2015,11(1):16-23. [22] CHRIST N,MOCKE V,FLURI F. Cerebral microbleeds are associated with cognitive decline early after ischemic stroke[J]. J Neurol,2019,266(5):1091-1094. [23] MOK V C T,LAM B Y K,WANG Z,et al. Delayed-onset dementia after stroke or transient ischemic attack[J]. Alzheimers Dement,2016,12(11):1167-1176. [24] SURAWAN J,AREEMIT S,TIAMKAO S,et al. Risk factors associated with post-stroke dementia:a systematic review and meta-analysis[J/OL]. Neurol Int,2017,9(3):7216[2022-10-25]. https://doi.org/10.4081/nir.2017.7216. [25] LANDE M B,KUPFERMAN J C. Blood pressure and cognitive function in children and adolescents[J]. Hypertension,2019,73(3):532-540. [26] YAFFE K,VITTINGHOFF E,PLETCHER M J,et al. Early adult to midlife cardiovascular risk factors and cognitive function[J]. Circulation,2014,129(15):1560-1567. [27] LANDE M B,BATISKY D L,KUPFERMAN J C,et al. Neurocognitive function in children with primary hypertension[J/OL]. J Pediatr,2017,180:148-155,e1[2022-10-25]. https://doi.org/10.1016/j.jpeds.2016.08.076. [28] GOTTESMAN R F,SCHNEIDER A L,ALBERT M,et al. Midlife hypertension and 20-year cognitive change:the atherosclerosis risk in communities neurocognitive study[J]. JAMA Neurol,2014,71(10):1218-1227. [29] LEVINE D A,GALECKI A T,LANGA K M,et al. Blood pressure and cognitive decline over 8 years in middle-aged and older black and white Americans[J]. Hypertension,2019,73(2):310-318. [30] QIU C,WINBLAD B,FRATIGLIONI L. The age-dependent relation of blood pressure to cognitive function and dementia[J]. Lancet Neurol,2005,4(8):487-499. [31] EMDIN C A,ROTHWELL P M,SALIMI-KHORSHIDI G,et al. Blood pressure and risk of vascular dementia:evidence from a primary care registry and a cohort study of transient ischemic attack and stroke[J]. Stroke,2016,47(6):1429-1435. [32] KITAGAWA K,OKU N,KIMURA Y,et al. Relationship between cerebral blood flow and later cognitive decline in hypertensive patients with cerebral small vessel disease[J]. Hypertens Res,2009,32(9):816-820. [33] RUITENBERG A,DEN HEIJER T,BAKKER S L,et al. Cerebral hypoperfusion and clinical onset of dementia:the Rotterdam study[J]. Ann Neurol,2005,57(6):789-794. [34] GONG L,GU Y Z,YU Q Y,et al. Prognostic factors for cognitive recovery beyond early poststroke cognitive impairment(PSCI):a prospective cohort study of spontaneous intracerebral hemorrhage[J/OL]. Front Neurol,2020,11:278[2022-10-25]. https://doi.org/10.3389/fneur.2020.00278. [35] HE M L,WANG J E,LIU N,et al. Effects of blood pressure in the early phase of ischemic stroke and stroke subtype on poststroke cognitive impairment[J]. Stroke,2018,49(7):1610-1617. [36] WANG Y,LI S P,PAN Y S,et al. The effects of blood pressure on post stroke cognitive impairment: BP and PSCI[J]. J Clin Hypertens(Greenwich),2021,23(12):2100-2105. [37] YAMAMOTO Y,NAGAKANE Y,TOMII Y,et al. High morning and bedtime home blood pressures strongly predict for post-stroke cognitive impairment[J]. J Stroke Cerebrovasc Dis,2016,25(8):1856-1863. [38] LEVINE D A,GALECKI A T,OKULLO D,et al. Association of blood pressure and cognition after stroke[J/OL]. J Stroke Cerebrovasc Dis,2020,29(7):104754[2022-10-25]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104754. [39] SACHDEV P S,BRODATY H,VALENZUELA M J,et al. Clinical determinants of dementia and mild cognitive impairment following ischaemic stroke:the Sydney stroke study[J]. Dement Geriatr Cogn Disord,2006,21(5/6):275-283. [40] VINCIGUERRA L,LANZA G,PUGLISI V,et al. Update on the neurobiology of vascular cognitive impairment:from lab to clinic[J/OL]. Int J Mol Sci,2020,21(8):2977[2022-10-25]. https://doi.org/10.3390/ijms21082977. [41] FENG R,ROLLS E T,CHENG W,et al. Hypertension is associated with reduced hippocampal connectivity and impaired memory[J/OL]. EBioMedicine,2020,61:103082[2022-10-25]. https://doi.org/10.1016/j.ebiom.2020.103082. [42] BENDER A R,RAZ N. Age-related differences in memory and executive functions in healthy APOE ε4 carriers:the contribution of individual differences in prefrontal volumes and systolic blood pressure[J]. Neuropsychologia,2012,50(5):704-714. [43] LANE C A,BARNES J,NICHOLAS J M,et al. Associations between blood pressure across adulthood and late-life brain structure and pathology in the neuroscience substudy of the 1946 British birth cohort(insight 46):an epidemiological study[J]. Lancet Neurol,2019,18(10):942-952. [44] LIU Y,DONG Y H,LYU P Y,et al. Hypertension-induced cerebral small vessel disease leading to cognitive impairment[J]. Chin Med J(Engl),2018,131(5):615-619. [45] MORTENSEN K N,SANGGAARD S,MESTRE H,et al. Impaired glymphatic transport in spontaneously hypertensive rats[J]. J Neurosci,2019,39(32):6365-6377. [46] HELD F,MORRIS A W J,PIRICI D,et al. Vascular basement membrane alterations and beta-amyloid accumulations in an animal model of cerebral small vessel disease[J]. Clin Sci(Lond),2017,131(10):1001-1013. [47] MACINTOSH B J,SHIRZADI Z,ATWI S,et al. Metabolic and vascular risk factors are associated with reduced cerebral blood flow and poorer midlife memory performance[J]. Hum Brain Mapp,2020,41(4):855-864. [48] IADECOLA C. The pathobiology of vascular dementia[J]. Neuron,2013,80(4):844-866. [49] ROSENBERG G A. Extracellular matrix inflammation in vascular cognitive impairment and dementia[J]. Clin Sci(Lond),2017,131(6):425-437. [50] STEVENS S L,WOOD S,KOSHIARIS C,et al. Blood pressure variability and cardiovascular disease:systematic review and meta-analysis[J/OL]. BMJ,2016,354:i4098[2022-10-25]. https://doi.org/10.1136/bmj.i4098. [51] CHO N,HOSHIDE S,NISHIZAWA M,et al. Relationship between blood pressure variability and cognitive function in elderly patients with good blood pressure control[J]. Am J Hypertens,2018,31(3):293-298. [52] OISHI E,OHARA T,SAKATA S,et al. Day-to-day blood pressure variability and risk of dementia in a general japanese elderly population:the Hisayama study[J]. Circulation,2017,136(6):516-525. [53] ALPÉROVITCH A,BLACHIER M,SOUMARÉ A,et al. Blood pressure variability and risk of dementia in an elderly cohort,the three-city study [J/OL]. Alzheimers Dement,2014,10(5 Suppl):S330-S337[2022-10-25]. https://doi.org/10.1016/j.jalz.2013.05.1777. [54] LEE J H,OH E,OH M S,et al. Highly variable blood pressure as a predictor of poor cognitive outcome in patients with acute lacunar infarction[J]. Cogn Behav Neurol,2014,27(4):189-198. [55] KIM Y,LIM J S,OH M S,et al. Blood pressure variability is related to faster cognitive decline in ischemic stroke patients:PICASSO subanalysis[J/OL]. Sci Rep,2021,11(1):5049[2022-10-25]. https://doi.org/10.1038/s41598-021-83945-z. [56] HILKENS N A,KLIJN C J M,RICHARD E. Blood pressure,blood pressure variability and the risk of poststroke dementia[J]. J Hypertens,2021,39(9):1859-1864. [57] MA Y,TULLY P J,HOFMAN A,et al. Blood pressure variability and dementia:a state-of-the-art review[J]. Am J Hypertens,2020,33(12):1059-1066. [58] MULLER M,VAN DER GRAAF Y,VISSEREN F L,et al. Hypertension and longitudinal changes in cerebral blood flow:the SMART-MR study[J]. Ann Neurol,2012,71(6):825-833. [59] BOS D,WOLTERS F J,DARWEESH S K L,et al. Cerebral small vessel disease and the risk of dementia:a systematic review and meta-analysis of population-based evidence[J]. Alzheimers Dement,2018,14(11):1482-1492. [60] ETO M,TOBA K,AKISHITA M,et al. Reduced endothelial vasomotor function and enhanced neointimal formation after vascular injury in a rat model of blood pressure lability[J]. Hypertens Res,2003,26(12):991-998. [61] TATASCIORE A,ZIMARINO M,RENDA G,et al. Awake blood pressure variability,inflammatory markers and target organ damage in newly diagnosed hypertension[J]. Hypertens Res,2008,31(12):2137-2146. [62] SCHMIDT R,SCHMIDT H,CURB J D,et al. Early inflammation and dementia:a 25-year follow-up of the Honolulu-Asia aging study[J]. Ann Neurol,2002,52(2):168-174. [63] AHMED H A,ISHRAT T,PILLAI B,et al. RAS modulation prevents progressive cognitive impairment after experimental stroke:a randomized,blinded preclinical trial[J/OL]. J Neuroinflammation,2018,15(1):229[2022-10-25]. https://doi.org/10.1186/s12974-018-1262-x. [64] IHLE-HANSEN H,THOMMESSEN B,FAGERLAND M W,et al. Blood pressure control to prevent decline in cognition after stroke[J/OL]. Vasc Health Risk Manag,2015,11:311-316[2022-10-25]. https://doi.org/10.2147/VHRM.S82839. [65] FORETTE F,SEUX M L,STAESSEN J A,et al. The prevention of dementia with antihypertensive treatment:new evidence from the systolic hypertension in Europe(Syst-Eur)study[J]. Arch Intern Med,2002,162(18):2046-2052. [66] TZOURIO C,ANDERSON C,CHAPMAN N,et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease[J]. Arch Intern Med,2003,163(9):1069-1075. [67] LI N C,LEE A,WHITMER R A,et al. Use of angiotensin receptor blockers and risk of dementia in a predominantly male population:prospective cohort analysis[J/OL]. BMJ,2010,340:b5465[2022-10-25]. https://doi.org/10.1136/bmj.b5465. [68] OH M S,YU K H,HONG K S,et al. Modest blood pressure reduction with valsartan in acute ischemic stroke:a prospective,randomized,open-label,blinded-end-point trial[J]. Int J Stroke,2015,10(5):745-751. [69] SANDSET E C,BATH P M,BOYSEN G,et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke(SCAST):a randomised,placebo-controlled,double-blind trial[J]. Lancet,2011,377(9767):741-750. [70] ANDERSON C,TEO K,GAO P,et al. Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease:analysis of data from the ONTARGET and TRANSCEND studies[J]. Lancet Neurol,2011,10(1):43-53. [71] DE HEUS R A A,TZOURIO C,LEE E J L,et al. Association between blood pressure variability with dementia and cognitive impairment:a systematic review and meta-analysis[J].Hypertension,2021,78(5):1478-1489. |
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