Abstract

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

Highlights

  • Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking

  • The 21 patients assessed at 3 months and deceased at 18 months had a mean age of 74.2 years (SD 11.6), 29% were females, mean education was 12.2 years (SD 3.8), and mean National Institutes of Health Stroke Scale (NIHSS) score at admittance was 4.5 (5.1)

  • Previous stroke was associated with poorer global z and attention at both 3 and 18 months (Figures 2G, 3G; Supplementary Table 2)

Read more

Summary

Introduction

Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. Hypertension is a known risk factor for dementia; knowledge about its association with PSCI is scarce [2,3,4,5]. The STROKOG consortium found associations between cognition and diabetes mellitus, previous stroke, hypertension, atrial fibrillation, and smoking early after a stroke [2]. Another recent study showed an association between cognition and blood pressure levels early after a stroke; these findings were explained by sociodemographic and clinical factors [8]

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call