Stroke considerably increases the risk of cognitive decline (CD) and dementia, with prevalence rates ranging from 24% to 33.3% within 5 years from stroke onset. In many cases, the cognitive decline develops abruptly, while in others, the decline develops insidiously over months or years at a rate which far exceeds the expected decline in this age group.
1,2After a stroke, patients frequently experience a spectrum of neuropsychological and motor deficits that can significantly interfere with their cognitive, communicative, and motor functions, resulting in impaired activities and function. Identifying those at higher risk of developing cognitive impairment has implications for the early initiation of treatment and for monitoring disease progression.Slowing of motor function is commonly observed with aging and is more pronounced in cognitively impaired individuals.3 Gait changes predict dementia as much as 6 to 10 years later 4 and may also precede the onset of even mild cognitive impairment, 4 which may occur as much as 12 years before the clinical presentation of cognitive changes. Moreover, the combination of motor and cognitive changes apparently is a stronger predictor of dementia than cognitive changes alone.6 Although the mechanisms of these motorcognitive interactions are not fully understood, subclinical pathological changes caused by cerebrovascular disease may Background and Purpose-Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors. Methods-Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event. Results-Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (P<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (P<0.001), slower gait (P<0.001), and fewer correct answers during dual-task walking (P=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36-27.15).
Conclusions-These