外文文献阅读——Association of Cerebral Small Vessel Disease and Cognitive Decline After Intracerebral Hemorrhage

期刊：Neurology 影响因子：11.8 

题目：Association of Cerebral Small Vessel Disease and  Cognitive Decline After Intracerebral  Hemorrhage

词汇：1.cerebral small vessel didease (CSVD）脑小血管疾病 

          2.cognitive decline 认知减退

          3.intracerebral hemorrhage（ICH）脑出血

翻译：脑小血管疾病与脑出血后认知衰退的关系

Abstract

Objective 目的

To determine whether MRI-based cerebral small vessel disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous intracerebral hemorrhage (ICH).

词汇：1.cognitive impairment 认知障碍 

翻译：为了确定基于 MRI 的脑小血管疾病 (CSVD) 负担评估是否除了临床和 CT 数据外，还能改善对自发性脑出血 (ICH) 后认知障碍的预测。

Methods 方法

We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed 3 validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA) -specific, and hypertensive arteriopathy (HTNA)–specific. We quantified cognitive performance by administering the modified Telephone Interview for Cognitive Status test. We utilized linear mixed models to model cognitive decline rates, and survival models for new-onset dementia. We calculated CSVD scores’cutoffs to maximize predictive performance for dementia diagnosis.

词汇：1.linear mixed models 线性混合模型

          2.cutoffs 截断值

翻译：我们分析了参加单中心前瞻性研究的 ICH 幸存者的数据。我们采用了 3 种经过验证的 CSVD 负担评分：全球性、脑淀粉样血管病 (CAA) 特异性和高血压动脉病 (HTNA) 特异性。我们通过管理修改后的认知状态电话访谈测试来量化认知表现。我们使用线性混合模型来模拟认知衰退率和新发痴呆的生存模型。我们计算了 CSVD 分数的截断值，以最大限度地提高痴呆诊断的预测性能。

拓展：线性混合模型？

建模公式DV~IV+（1+R.Slope/R.Factor)

IV:固定因子，要考察的变量

Random factor 随机因子

1/random intercept 不同个体因变量分布不同（1：随机截距）

random slope 不同个体自变量与因变量关系不同（随机斜率）

Results

We enrolled 612 ICH survivors, and followed them for a median of46.3 months (interquartile range 35.5–58.7). A total of 214/612 (35%) participants developed dementia. Higher global CSVD scores at baseline were associated with faster cognitive decline (coefficient −0.25,standard error [SE] 0.02) and dementia risk (sub–hazard ratio 1.35, 95% confidence interval 1.10–1.65). The global score outperformed the CAA and HTNA scores in predicting post-ICH dementia (all p < 0.05). Compared to a model including readily available clinical and CT data, inclusion of the global CSVD score resulted in improved prediction of post-ICH dementia (area under the curve [AUC] 0.89, SE 0.02 vs AUC 0.81, SE 0.03, p = 0.008 for comparison). Global CSVD scores ≥2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis.

词汇：1.interquartile range 四分位距

翻译：我们招募了 612 名 ICH 幸存者，平均随访 46.3 个月（四分位距 35.5-58.7）。共有 214/612 (35%) 名参与者患上了痴呆症。基线时全球 CSVD 得分越高，认知能力下降越快（系数 -0.25，标准误差 [SE] 0.02）和痴呆风险（亚风险比 1.35，95% 置信区间 1.10-1.65）。全球分数在预测 ICH 后痴呆方面的表现优于 CAA 和 HTNAscores（所有 p < 0.05）。与包含现成临床和 CT 数据的模型相比，纳入全球 CSVD 评分可改善对 ICH 后痴呆的预测（曲线下面积 [AUC] 0.89，SE 0.02 对比 AUC 0.81，SE 0.03，p = 0.008比较）。全球CSVD评分≥2对痴呆诊断具有最高的敏感性（83%）和特异性（91%）。

Conclusions

A validated MRI-based CSVD score is associated with cognitive performance after ICH and improved diagnostic accuracy for predicting new onset of dementia.

翻译：经验证的基于 MRI 的 CSVD 评分与 ICH 后的认知表现相关，并提高了预测新发痴呆症的诊断准确性。

（9.08）持续更新

Intracerebral hemorrhage (ICH) is among the most severe forms of acute stroke, accounting for almost half of stroke-related morbidity and mortality.Recent advances in ICH surgical management and neurocritical care resulted in reduced mortality, but did not consistently reduce disability among survivors. Multiple recent studies clarified that ICH survivors are at very high risk of poststroke dementia, with cognitive impairment being a primary contributor to ICH-related long-term disability.Identification of ICH survivors at high risk for cognitive impairment is therefore a priority, in order to guide secondary stroke prevention efforts and inform further research into amelioration of long-term ICH outcomes.