Pre‐stroke chronic cerebrovascular disease is a major determinant for response to structured cognitive rehabilitation following acute ischemic strokes

Abstract

AbstractBackgroundPost Stroke Cognitive Impairment (PSCI) is seen in 40‐60% of patients with ischemic strokes. Response of patients with PSCI to structured cognitive rehabilitation is not clearly understood. We evaluated baseline variables that predict response to an eight‐week non‐pharmacological intervention among patients with mild strokes and compared the responses to non‐pharmacological intervention among acute stroke patients with and without chronic cerebrovascular disease (CVD).Method139 ischemic stroke survivors were recruited from a tertiary hospital in Singapore. All patients underwent an eight‐week structured group cognitive rehabilitation programme (Figure 1). Baseline, immediate post‐intervention (Immediate‐PI) and 6‐month post intervention (6‐month‐PI) global cognitive and quality of life (QOL) outcomes were assessed by Montreal Cognitive Assessment (MoCA) and Dementia‐Quality of Life (DemQOL). Regression analyses evaluated the influence of cognitive rehabilitation on outcomes.ResultThe mean age of subjects were 63.6 (±9.66) with 64.4% males. Baseline MoCA and DemQOL scores were 23.30 (±3.05) and 79.16 (±14.80). At Immediate‐PI, patients with more past strokes (p = 0.033) and severe white matter hyperintensities (WMH) (p = 0.048), benefited less on global cognitive outcome (Table 1). Male patients (p = 0.074) and patients with more severe WMH (p = 0.048) benefited less on QOL outcome (Table 2). At 6‐month‐PI, patients with microhemorrhages in the deep region (p = 0.002) were less likely to sustain cognitive improvement. With every past stroke experienced, patients were less likely to experience an improvement in MoCA score Immediate‐PI (OR = 2.17, 95% CI: 0.980‐4.813, p = 0.056). with severe WMH were less likely to experience an improvement in MoCA scores Immediate‐PI compared to baseline (OR = 2.13, 95% CI: 1.04‐4.38, p = 0.039). Finally, patients with microhemorrhages in the deep region were less likely to retain the improvements in MoCA at 6‐month‐PI (OR = 19.93, 95% CI: 1.04‐384, p = 0.047)ConclusionPre‐stroke CVD were associated with worse cognitive and QoL outcomes post cognitive rehabilitation. Understanding factors that result in poor response to rehabilitation will allow clinicians to better select stroke survivors for cognitive rehabilitation. Future research could build on these findings and allocate more resources to these at‐risk groups for post‐stroke care, therefore reducing the global burden of stroke and ensuring a better QOL for stroke survivors.