Abstract TP560: Cognitive Impairment Should Be an Independent Predictor of Poor Functional Outcome in Acute Minor Stroke

Abstract

Objective: The evaluation of cognitive status is not routine in the acute stroke setting. The aim of the study was to elucidate the association between cognitive function and functional outcome in acute minor ischemic stroke patients. Methods: From December 2016 to November 2017, patients with acute minor ischemic stroke (prehospital modified Rankin Scale (mRS) ≤1 and National Institute of Health Stroke Scale (NIHSS) score ≤3) who were admitted to our department were prospectively analyzed. Prestroke cognitive state was estimated by Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which was completed by the patient’s relative at the time of admission. Cognitive performance was measured using the Japanese version of Montreal Cognitive Assessment (MoCA-J) within the first 7 days of admission. Cognitive impairment was defined as MoCA-J <23. Functional outcomes were assessed using the mRS at the time of discharge. A poor discharge outcome was defined as an mRS score of 3-5 or death (mRS score of 6). The impacts of cognitive function on outcome were assessed by multivariate logistic regression analyses. Results: Overall, 581 consecutive patients with acute ischemic stroke admitted to our department during the study period. Finally, 128 patients with minor ischemic stroke (median age 72years) were enrolled. In total, 74 (58%) patients had impaired cognitive impairment in the acute phase. Age ( P = 0.0161), NIHSS score on admission ( P <0.0001), IQCODE ( P =0.0167), Moca-J ( P <0.0001), dyslipidemia ( P =0.0101), and sex ( P =0.0222) were different between good and poor outcome. Multivariate analysis showed that high NIHSS score (odds ratio [OR], 7.30; 95% confidence interval [CI], 2.33-39.95, P < 0.0001) upon admission as well as low Moca-J score (OR, 1.32; 95% CI, 1.11-1.61, P = 0.0006) was independently associated with poor functional outcome. Conclusion: Cognitive impairment in acute minor ischemic stroke was common and independently associated with poor functional outcome after adjusting for the effects of stroke severity, prestroke cognitive status, and various risk factors.