Prevalence of post-stroke cognitive impairment in china: a community-based, cross-sectional study.

Yanji Qu,Siyan Zhan,Xiaolu Nie,Na Li,Yiqing Hu,Weihua Chen,Jinwei Wang,Qingmei Tao,Yun Zhou,Lin Zhuo,Jing Hu,Robert Stewart

doi:10.1371/journal.pone.0122864

Abstract

International hospital-based studies have indicated a high risk of cognitive impairment after stroke, evidence from community-based studies in China is scarce. To determine the prevalence of post-stroke cognitive impairment (PSCI) and its subtypes in stroke survivors residing in selected rural and urban Chinese communities, we conducted a community-based, cross-sectional study in 599 patients accounting for 48% of all stroke survivors registered in the 4 communities, who had suffered confirmed strokes and had undergone cognitive assessments via the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Hachinski Ischemia Scale (HIS). Detection of PSCI was based on scores in these neuropsychological scales. Factors potentially impacting on occurrence of PSCI were explored by comparing demographic characteristics, stroke features, and cardiovascular risk factors between patients with and without PSCI. The overall prevalence of PSCI was 80.97% (95%CI: 77.82%-84.11%), while that of non-dementia PSCI (PSCI-ND) and post-stroke vascular dementia (PSD) was 48.91% (95%CI: 44.91%-52.92%) and 32.05% (95%CI: 28.32%-35.79%), respectively. Prior stroke and complications during the acute phase were independent risk factors for PSCI. The risk of recurrent stroke survivors having PSCI was 2.7 times higher than for first-episode survivors, and it was 3 times higher for those with complications during the acute phase than for those without. The higher prevalence of PSCI in this study compared with previous Chinese studies was possibly due to the combined effects of including rural stroke survivors, a longer period from stroke onset, and different assessment methods. There is an urgent need to recognize and prevent PSCI in stroke patients, especially those with recurrent stroke and complications during the acute phase.

Highlights

Stroke is a major cause of disability and mortality for adults worldwide [1], and is the second most common cause of cognitive impairment, just behind neurological disease
Some significant differences between rural and urban patients were observed for certain demographic characteristics, stroke features, and cardiovascular risk factors
In other studies of post-stroke cognitive impairment (PSCI) in China, hospital-based cohort studies by Zhou et al [13] and Zhang et al [14] found that the incidence of PSCI at 3 months after stroke was 32.2% and 27.9%, respectively, while in an urban community-based, cross-sectional study, Tu et al [15] reported that the prevalence of PSCI in ischemic stroke survivors aged !40 years was 41.8%

Summary

Introduction

Stroke is a major cause of disability and mortality for adults worldwide [1], and is the second most common cause of cognitive impairment, just behind neurological disease. Stroke has been reported to increase the risk of cognitive impairment at least 5 to 8 times [2,3]. Epidemiological studies have suggested an increase in the incidence of stroke in China [16], which may result in an increased prevalence of PSCI. Data on PSCI in China are scarce, especially at the community level. The aim of this community-based, cross-sectional, observational study was to determine the prevalence of PSCI and its subtypes in stroke survivors residing in selected rural and urban Chinese communities and explore the impact of potential risk factors

Methods

Results

Discussion

Conclusion