PB 23 Factors predicting global cognitive ability 6 month after stroke – preliminary results from the Phys-Stroke trial

Abstract

Introduction Stroke is one of the most frequent causes of chronic and often severe language and motor impairments. Moreover, stroke increases the risk of developing cognitive impairments or even dementia over time ( Pendlebury and Rothwell, 2009 ). Although recent studies investigated predictors of cognitive decline after stroke, several questions remain. In particular, it needs to be clarified whether therapies applied during the rehabilitation phase may reduce or even prevent cognitive decline. Question How do patients with cognitive improvement 6 months post stroke differ in their baseline characteristics (demographics, vascular co-morbidities, therapy during rehabilitation and in the outpatient setting) from patients without improvement? Methods In the randomized, multi-center trial Phys-Stroke ( Floel et al., 2014 ) we assess 215 subacute stroke patients (5–45 days post-onset; Barthel-Index ⩽ 65). All patients received standard therapy with about 113 ± 53 h of global therapy time (physio, language, occupational and neuropsychological therapy) over the course of 6 months. Associations between improvement in cognitive function 6 months after stroke, operationalized with the Montreal Cognitive Assessment (MOCA), and the above mentioned factors were investigated. Results 67 patients (69 ± 11 years, 29% female, Barthel-Index 45 ± 15) were included in this analysis. At Baseline (26 ± 12 days post-stroke) patients revealed cognitive deficits (MOCA Score 22.9 ± 6.1). Vascular comorbidities were frequently noted (hypertension 83%, diabetes mellitus 29%, previous stroke 16%). 18 patients were identified, which showed no sign of improvement in the MOCA between Baseline and 6 months post-stroke. Domains most strongly affected in the subtests of the MOCA were speech, memory and attention (all p-values Discussion Our data underscore the significance of age as predictor for cognitive function following stroke. Global therapy time, vascular comorbidities and demographic variables showed only limited predictive value on improvement of cognition after stroke. In upcoming analyses, we plan to examine whether a specialized therapy (e.g. cognitive training; study intervention intensive aerobic vs relaxation training) or the integrity of hippocampal structures modify cognitive functioning in the months following the acute event.