A-150 Cognitive Impairment in Patients with Infratentorial Stroke Undergoing Acute Stroke Rehabilitation

Abstract

Abstract Objective: Brainstem, pontine, and cerebellar (infratentorial) stroke has been associated with motor and cranial nerve dysfunction. However, case reports and clinical observations suggest that cognitive impairment may be present. Acute inpatient stroke rehabilitation is a critical time to implement cognitive interventions; however, intervention opportunities may be missed if rehabilitation providers are unaware of cognitive dysfunction and do not assess for deficits in patients with infratentorial strokes. Our objective was to evaluate cognition in individuals with infratentorial strokes undergoing acute inpatient rehabilitation. Method: Participants were recruited as part of an ongoing clinical trial on an acute inpatient rehabilitation unit. Participants (N=7; Median age=69 years (range 53-88); Median education=16 years (range: 6-20); 4 female) with recent onset infratentorial stroke were administered the Tablet-based Cognitive Assessment Tool on admission to the unit. Performance was evaluated via normative comparison (impairment defined as ≤1.5 SD below the normative mean) and by direct comparison to participants with supratentorial strokes (N=17) using Mann-Whitney U tests. Results: Participants with infratentorial stroke demonstrated impairment across tasks of attention/working memory, set-shifting, and inhibition (Median age-normed z-score ranged from -2.35 to -3.86). No statistically significant differences were observed between patients with infratentorial and supratentorial strokes on any cognitive tasks (all p’s>.25). Conclusions: In acute inpatient rehabilitation, infratentorial stroke may cause impairment in attention, working memory and executive functioning similar to the impairment seen in patients with supratentorial stroke. Although follow-up analyses with larger samples are warranted, results suggest that early identification and intervention for cognitive deficits should be part of rehabilitation for patients with infratentorial strokes.