Cognitive impairment in lacunar strokes: The SPS3 trial

Abstract

Objective Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. Methods All English-speaking participants in the SPS3 trial (NCT: 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z-scores using published norms. Those with impairment (z≤-1.5) in memory and/or non-memory domains were classified as having Mild Cognitive Impairment (MCI). Results Among the 1636 participants, average z scores on all tests were below zero with the largest deficits seen on tests of episodic memory (range of means -0.65 to -0.92), verbal fluency (mean -0.89), and motor dexterity (mean -2.5). Forty-seven percent were classified as having MCI: 36% amnestic, 37% amnestic multidomain, 28% non-amnestic. Of those with Rankin score 0-1 and Barthel score=100, 41% had MCI. Younger age [odds ratio (OR) per 10-yr increase=0.87], male sex (OR 1.3), less education (OR 0.13-0.66 compared to 0-4 yrs education), post-stroke disability (OR 1.4), and impaired activities of daily living (OR 1.8) were independently associated with MCI. Conclusions In this large, well characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.

Longitudinal Effect of Stroke on Cognition: A Systematic Review

“…With an aging population and a decline in mortality after stroke,4 the rates of poststroke cognitive impairment will increase. Despite being as common as other neurological deficits, such as motor and sensory, cognitive impairment is often overlooked in the follow‐up of stroke survivors unless they have progressed to dementia 5. This may well be because these patients are able to maintain some level of personal independence despite poor cognitive recovery 6…”

Cognitive Impairment in Ischaemic Lacunar Stroke

“…The observation of impaired processing speed, motor dexterity and executive function was consistent with the impairment pattern hypothesised for subcortical ischaemic disease. 46 On the other hand, the observation of episodic memory deficits was a novel aspect of the study given that incident lacunes have been reported to impact processing speed and motor control but not memory. 46 The authors emphasised that mild cognitive impairment found in half of the participants is an important clinical sequela of lacunar stroke, which in turn is more prevalent than physical disability defined by m-Rankin score ≥2 (33 %) and present in 41 % of patients with no significant disability (m-Rankin score 0-1' Barthel index score 100).…”

“…46 On the other hand, the observation of episodic memory deficits was a novel aspect of the study given that incident lacunes have been reported to impact processing speed and motor control but not memory. 46 The authors emphasised that mild cognitive impairment found in half of the participants is an important clinical sequela of lacunar stroke, which in turn is more prevalent than physical disability defined by m-Rankin score ≥2 (33 %) and present in 41 % of patients with no significant disability (m-Rankin score 0-1' Barthel index score 100). It is speculated that the cognitive effects of lacunar stroke are at least as important as disability related to motor or sensory deficits, and can occur in their absence.…”

“…45 All English-speaking participants in SPS3 underwent neuropsychological testing at baseline (n=1,636). 46 A total of 47 % of the cohort met psychometric criteria for mild cognitive impairment with amanestic deficits as prevalent as non-amnestic. 46 Younger age, male gender, less education, post-stroke disability and impaired activities of daily living were independently associated with mild cognitive impairment.…”

“…46 A total of 47 % of the cohort met psychometric criteria for mild cognitive impairment with amanestic deficits as prevalent as non-amnestic. 46 Younger age, male gender, less education, post-stroke disability and impaired activities of daily living were independently associated with mild cognitive impairment. The observation of impaired processing speed, motor dexterity and executive function was consistent with the impairment pattern hypothesised for subcortical ischaemic disease.…”