Risk factors in survival of vascular dementia

• Main Authors: Yun-Ru Lu, 盧韻如
• Other Authors: Shu-Hui Chang
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/47901275615867116631

碩士 === 臺灣大學 === 流行病學研究所 === 98 === Background There were many survival suturies of Alzheimer''s Disease or oveall dementia. But,the study about survival of vascular dementia was few.It is fact that the etiologies of dementia are variable.The effect of vascular risk factors on dementia mortality were underestimated due to the error anaylsis of oveall dementia patients rather than vascular dementia patients.Our study was a longitudinal study of patients of vascular dementia.We recorded the whole history from stroke to vascular dementia and final mortality course in hospital.Based on the records , we want to know what risks factors were related to mortality of vascular dementia. Objective To investigate what risks factors were contributioned to mortality of vascular dementia.The risk factors include as follows: age、gender、diabetes mellitus、hypertension、angima、atrial fibrillation、poststrpke bed-ridden state、poststroke epilepsy、congestive heart failure、sepsis、the time between stroke and dementia、poststroke brain image findings.According to the survival study of vascular dementia, we could know what risk factors were highly related to mortality and we can early prevent it with drugs or health education. Method We used medical record review system to identify cases of vascular dementia from January 1, 2004 to December 31, 2009. 54 patients were identified by the criteria of National Institute of Neurological Disorders and Stroke -Association International pour la Recherché et l''Enseignement en Neurosciences (NINDS –AIREN criteria) Patients with VaD were followed from the day of VaD diagnosis to death, or the end of study. All the patients were arranged a series of tests as follows, neurological examination revealed focal neurological symptoms and signs, and serological test for dementia survey, such as T4, TSH, and VDRL. Besides, Brain CT or MRI was done to check the poststroke states and brain atrophy. Cox proportional hazards models were used to evaluate the effects of risk factors on VaD. In addition, the estimated median survival time and five-year survival rate were obtained from the Kaplan-Meier method. Result The mean age of VaD was 81.53±7.36 years.Five year survival rate was 34%. At the ending of study, there were 12 deaths among patients. There were 8 patients died from aspiration pneumonia, 1 patients died from recurrent stroke, and 1 patient died from lung cancer,1 patient died from traumatic SAH due to fall down. The RR of death was 32.27(95%CI, 6.04-172.4) in VaD patients with congestive heart failure. The RR of death was 44.79(95%CI,12.10-165.8) in VaD patients with septic shock.The Kaplan-Meier survival curves showed the trend in poor survival amongVaD patients with multiple vascular factors.Besides,VaD patients with brain image showed periventricular white matter change has better survival tham patients with brin image showed a single strategically infarct. Conclusion Five-year survival rate was 34%. Aspiration Pneumonia was the major mortality cause in our patients. Septic shock and CHF were time-dependent variables in survival of VaD. The major cause of Sepsis was aspiration pneumonia.The RR of death was 33.20 in VaD patients with septic shock adjusted by CHF.There was trend with lower survival rate among VaD patients of multiple vascular risk factors.