腦中風在台灣是僅次於癌症的第二大死因，也是造成失智症的危險因子之一。大部分的腦中風患者患有一種或多種慢性疾病，而慢性疾病也是失智症的危險因子之一。因此，慢性疾病與腦中風具有明顯相關性，而腦中風與失智症亦為高度相關。本研究採用多狀態半馬可夫鏈模型和Cox比例風險模式分析各種慢性病對失智症的危險因素與關聯性。針對在全民健康保險研究資料庫2000年至2010年期間診斷為腦中風的10,627位患者，進行研究。以多狀態半馬可夫鏈模型建模，將慢性病作為起始狀態、出血性腦中風和梗塞性腦中風作為中間狀態，血管性失智與非血管性失智作為吸態。此外，本研究建構模擬模型以預測腦中風病患從慢性病發到中風與中風到失智的轉移時間與醫療費用。研究結果顯示糖尿病患者有較高的風險發生腦中風，而腦中風患者有較高的風險發生非血管性失智。降血壓藥物在大部分的轉移過程中具有顯著的影響，而復健治療對梗塞性腦中風患者具有顯著影響。模擬結果顯示糖尿病患者發生腦中風的時間較短，其他慢性疾病患者有較高的藥物治療費用。此外出血性腦中風患者比梗塞性腦中風患者具有較短的轉移時間發生失智與較高的治療費用。

This study employed a multistate semi-Markov model and the cox proportional method to analysis associations of various chronic risk factors with the dementia. We included 10,627 patients of stroke diagnosed between 2000 and 2010 who were recruited in National Health Insurance Research Database (NHIRD) for a population-based study, and retrospectively followed up until the end of 2010. Chronic, hemorrhagic stroke and ischemic stroke were included as intermediate states, and vascular dementia and non-vascular dementia were included as competing absorbing states. Furthermore, constructing a simulation model predicts the metastasis time and medical expenditure from chronic disease to stroke and stroke to dementia. In Taiwan, stroke is the second leading cause of death after cancer and also one of the risk for dementia. Most of the stroke patients suffer from one or more chronic diseases, and chronic diseases are also one of the risk factors for dementia. Therefore, chronic were significantly associated with all stroke, stroke involvement was significantly dementia. Combination with Cox models, multistate semi-Markov model allow for dissection of relationship between stroke and dementia under various covariate. The results show that diabetes mellitus patients have higher risk transfer to stroke and stroke patients have higher risk transfer to non-vascular dementia. Blood pressure lowing drug have a significant effect in the most metastatic process among all and the rehabilitation has significant effect on ischemic stroke patients. Simulation results shows diabetes mellitus patients have shorter metastasis time transfer to stroke and other chronic disease patients have higher treatment cost. In addition, hemorrhagic stroke patient have shorter metastasis time and higher treatment cost than ischemic stroke patients of transfer to dementia.

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