Abstract WMP33: Cognitive Outcomes In Patients With A Prior History Of Stroke Participating In Inpatient Rehabilitation

Abstract

Introduction: We sought to investigate the impact of prior stroke on cognitive improvement in stroke patients participating in inpatient rehabilitation. Methods: This was a retrospective review of clinical data from inpatient stroke rehabilitation (ISR) units collected from 09/2017- 08/2019. Age at onset, stroke type (ischemic or intracerebral hemorrhage (ICH)), therapy days, sex, and past medical history of stroke, diabetes, hypertension (HTN) were extracted as predictors of outcome in ISR. The baseline level of disability upon admission to acute stroke care was accounted for with pre-morbid modified Rankin scale (mRS) score and initial NIH Stroke Scale (NIHSS). The outcome variable of interest was total discharge cognitive functional independence measure (TDC-FIM) from ISR. FIM admission to ISR was controlled for in the model. Results: The data of 681 patients were used in a Lasso regression analysis (Figure 1), and of these patients there were 202 patients with a history of prior stroke. Univariate analysis showed a significant difference between prior stroke and first-time stroke groups with respect to pre-morbid mRS (p<0.001), initial NIHSS (p = 0.003), HTN (p=0.004), and stroke type (p=0.023). Lasso regression indicated that patients with diabetes had a 0.58 point decrease in TDC-FIM while those with HTN had a 0.38 point decrease as compared to patients who did not have these vascular risk factors. Patients with ischemic stroke type had a 0.73 point decrease in the TDC-FIM as compared to those who had an ICH. Prior stroke and the patient’s sex had no effect on TDC-FIM. The R-squared of the model was 0.74. Conclusion: By controlling for vascular risk factors, our findings show no difference in TDC-FIM with respect to prior stroke. This is different from prior studies that found prior stroke was associated with worse cognitive outcomes at discharge from ISR. Our results indicate that managing HTN and diabetes is imperative for post-stroke cognitive rehabilitation