Abstract
BackgroundMotor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition.MethodsThe Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity.ResultsOf 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [− 11.726, − 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [− 2.672, − 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR.ConclusionThree months after suffering mainly minor strokes, 30–40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline.Trial registrationClinicalTrials.gov Identifier: NCT02650531.
Highlights
Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related
Motor performance was associated with memory, executive function and global cognition
Inclusion criteria were as follows: a diagnosis of stroke according to the WHO criteria [25] or findings on magnetic resonance imaging (MRI) compatible with intracerebral haemorrhage or infarction; symptom onset within 1 week of admission; age > 18 years; the ability to communicate in Norwegian; and residing within the catchment area of the participating hospitals
Summary
Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. Post-stroke motor and cognitive impairments are prevalent, and even though function improve during the first 3 months after stroke [2], approximately one fifth of stroke patients experience stroke-related disability 3 months post-stroke [3], highlighting the need of early detection and prevention of further deterioration of function. In a study assessing stroke patients 3-6 months poststroke, Sachdev et al reported a prevalence of mild cognitive impairment and dementia of 37 and 21%, respectively [6], underlining the importance of addressing cognitive impairments following stroke. Assessments of motor and cognitive functions have established roles in the follow-up of stroke patients but have traditionally been studied, diagnosed and managed as distinct entities [7]. The stroke lesion itself, comorbid cerebrovascular disease and neurodegeneration may all cause both cognitive and motor impairments [8]
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