Cognitive impairment and disability after arterial stroke in older adults: A hospital‐based study

Abstract

AbstractBackgroundStroke and cognitive impairment often co‐exist in older adults. Every one minute three people get stroke in India, who are potentially at risk for cognitive impairment. However the literature on this area is limited from India.The objective is study the cognitive impairment in older adults with arterial stroke. To study the relation between the cognitive impairment and disability.MethodSample includes patients above the age of 45 years with arterial stroke seeking treatment from NIMHANS outpatient departments. Ethical clearance was obtained. Patient underwent neurological examination. Standard instruments applied were Modified Rankin scale (MRS), Barthel index (BI), Stroke specific quality of life (SS‐QOL) and Addenbrooke’s cognitive examination (ACE‐III).Results100 stroke patients were recruited as per the inclusion criteria. The sample included 75% males (M:F‐ 3:1), with mean age of 63.98 (SD‐8.45) years. Among them majority were living with spouse (87%), from urban background (75%) and 52% had education of high school and above. Median duration of stroke at assessment was 5 months. The mean score on MRS, BI and SS‐QOL were 2.12 (SD‐1.13), 82.0 (18.64) and 180 (SD‐35.175)respectively. Among our patients 10% meets criteria for vascular dementia and 20% for mild cognitive impairment.On ACE‐III the mean score was 65.50 (SD‐17.72) with score on Attention‐13.21 (SD‐4.54), Memory‐15.11 (SD‐7.07), Fluency‐5.63 (SD‐3.174), Language‐19.92 (SD‐5.59),Visuo‐spatial‐9.69 (SD‐4.51). There was positive correlation between ACE‐ III scores and Barthel index (r= 0.526; p<0.001)and SS‐QOL (r=0.716; P<0.001).There was negative correlation between ACE‐III score and MRS (r= ‐ 0.599; p<0.001).ConclusionIn our study, one‐third of sample had cognitive impairment, at 5 months (median) after stroke.The prevalence of post stroke cognitive impairment is on the lower side as compared to recent meta‐analysis (Barbay et al., 2018; Merriman et al., 2019) which could be due to inclusion of outpatient sample and time of assessment. Cognitive impairment has negative impact of functioning and quality of life in stroke patients which is in agreement with previous studies.