EFFECT OF ADMISSION BLOOD PRESSURE VARIABILITY OF ACUTE STROKE ON LONGITUDINAL POST-STROKE COGNITIVE CHANGES

Abstract

Post-stroke cognitive impairment (PSCI) is one of major sequela of stroke. However, most predictors for PSCI are non-modifiable during acute stroke stage. Blood pressure (BP) variability was associated with poor cardiovascular outcomes after stroke. We aimed to investigate the effect of BP variability during acute stroke to longitudinal cognitive changes after stroke. Patients who were admitted for acute ischemic stroke within 2 days of symptom onset were enrolled. BP levels, which were evaluated within 7 days of symptom onset, were queried using clinical database warehouse in electronic medical records, and patients with at least 5 times BP measurements were included. BP-related variables – mean, minimum, maximum, range, standard deviation (SD), coefficient of variance (CV%) were calculated. Longitudinal changes of mini-mental state examination (MMSE), digit symbol coding, and verbal learning test-delayed recall were evaluated using multilevel hierarchical mixed model analysis. A total of 289 patients were enrolled having a median follow-up duration of 35.5 months. Mean baseline age was 68.7±10.0 years, median score of initial National Institutes of Health Stroke Scale was 3 (interquartile range, IQR 4). Mean intervals between index stroke and admission was 0.5±0.5 days, and median number of blood pressure measurements was 43 (IQR 39). Mean SD and CV% was 13.3±3.5 and 9.6±2.3 of systolic BP, and 9.5±2.3 and 12.6±3.4 of diastolic BP. As for the MMSE, baseline median score was 25 (IQR 7), and delta MMSE score during follow-up ranged from -15 to 12. Baseline median scores of digit symbol coding and verbal learning test-delayed recall was 28 (IQR 28) and 3 (IQR 4), respectively. When SD was categorized as quartiles, the median score of MMSE changes in the upper quartile groups showed a larger negative value than those of the lower quartile groups. (Figure.) However, there was no significant predictors for longitudinal cognitive change in the final multilevel hierarchical mixed model adjusted for predetermined demographic, clinical, and neuroimaging covariates. (Table.)