Abstract 2554: Long-term Neuropsychological Outcomes after Childhood Arterial Ischemic Stroke (AIS)

Abstract

Background: Childhood AIS affects 2-6/100,000 children per year and is associated with significant morbidity and mortality. Although previous reports have demonstrated lower IQ’s in children following AIS as compared to healthy children, understanding of cognitive function more broadly in childhood AIS remains limited. Methods: In order to address this gap in knowledge, we collected data on demographics, stroke type, stroke size, stroke location, and long-term neuropsychological outcome, (defined as testing that occurred at least 10 months after stroke diagnosis). Patients were enrolled in an institution-based prospective cohort study of childhood AIS, comprising 63 children diagnosed with AIS from March 2006-August 2011. Neuropsychological assessment employed age-appropriate measures. In addition to IQ, other cognitive domains were tested, including academics, visual-motor skills, memory, and language. Single-tailed one-sample t-tests were performed to compare the childhood AIS group to the normative mean for neuropsychological exams. Furthermore, ANOVA analyses were used to compare neuropsychological outcome among subgroups of interest. Results: 42 patients in our cohort had neuropsychological testing available at least 10 months after stroke diagnosis: 21 males and 21 females, with a mean age of 7 years at time of stroke (SD= +/-5.43). Mean neuropsychological testing was at 36 months after AIS (SD= +/- 30.72). Mean IQ for childhood AIS patients was 93.8 (SD= +/-17.75) and was significantly lower than the population mean (p < .05). Cognitive profile testing revealed significantly decreased functioning in the visual-motor (mean standard score = 84.1 [SD = +/-17.32], p <.001) and language domains (mean standard score = 82.9 [SD= +/-25.15], p = .002). By contrast, academic and memory profiles were not significantly reduced (standard score means of 95.1 and 97.0, respectively). In sensitivity analyses that excluded patients known to have pre-morbid (i.e., pre-AIS) neuropsychological abnormalities, visual-motor and language domains remained significantly reduced as compared to the population mean (p < 0.001, and p= 0.04, respectively). Stroke type, stroke size, stroke location and arteriopathy were not significant predictors of long-term neuropsychological outcome. Conclusions: Long-term neuropsychological outcome in this cohort confirms that childhood AIS patients have lower IQ’s than healthy children; in addition, results indicate that specific visual-motor and language skills are even more significantly affected. We recommend that children with AIS be comprehensively evaluated for the need for targeted interventions to improve visual-motor and language skills, and that the effectiveness of these interventions be evaluated in future studies.