Abstract
BackgroundCognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. The aim of this study was to profile cognitive impairment of stroke survivors at six months, and to identify factors associated with cognitive impairment post-stroke, focusing on indicators of adequate secondary prevention and psychological function.MethodsParticipants were assessed at six months following an ischaemic stroke as part of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke study (ASPIRE-S), which examined the secondary preventive and rehabilitative profile of patients in the community post-stroke. Cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA).ResultsTwo-hundred and fifty-six stroke patients were assessed at six months. Over half of the sample (56.6%) were found to have cognitive impairment, with significant associations between cognitive impairment and female sex (odds ratio (OR) = 1.6, 95% CI 1.01-2.57) and history of cerebrovascular disease (OR = 2.22, 95% CI 1.38-3.59). Treatment with antihypertensive medications (OR = .65, 95% CI .44-.96) and prescription of anticoagulant therapy (OR = .41, 95% CI .26-.68) were associated with reduced likelihood of cognitive impairment, however increasing number of total prescribed medications was moderately associated with poorer cognitive impairment (OR = 1.12, 95% CI 1.04-1.19).ConclusionsFindings reveal levels of cognitive impairment at 6 months post-stroke that are concerning. Encouragingly, aspects of secondary prevention were identified that may be protective in reducing the incidence of cognitive impairment post-stroke. Neuropsychological rehabilitation post-stroke is also required as part of stroke rehabilitation models to meet the burden of post-stroke cognitive impairment.
Highlights
Cognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit
The aim of the analysis presented in this study was to comprehensively profile poststroke cognitive impairment and, in doing so, to determine which factors were associated with cognitive impairment in this stroke survivor cohort
52% of all referred cases were ineligible for study inclusion at baseline, with the most common reasons for noninclusion recorded as patient diagnosed as transient ischaemic attack (TIA) following MRI imaging (17.9%), or too medically unwell during hospital admission (16%)
Summary
Cognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. Emerging evidence suggests that appropriate secondary prevention of recurrent events may reduce the burden of post-stroke cognitive impairment and progression to dementia. A recent UK study [11] suggested that appropriate management of vascular risk factors post-stroke was associated with longer term protective benefits for onset of cognitive impairment. Management of vascular risk factors, including adequate blood pressure control, lipid control and anti-thrombotic therapy were associated with reduced risk of post-stroke cognitive impairment over a 15 year follow-up period
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