Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

Abstract

Background: The long-term (>12 months) prevalence, predictors, and trajectory of post-stroke cognitive deficits are not well established, especially at a community level. This study investigated the longitudinal course and prevalence of cognitive impairment in an incidence cohort, identifying factors associated with declining cognition. Methods: Two hundred fifty-seven participants (mean age = 67.93 ± 13.59) of first-ever stroke survivors, completed cognitive assessments within 2 weeks post stroke, and/or 1, 6, 12, and 48-month. Multivariate linear and logistic models were used to identify baseline predictors (reported as OR with 95% CI) and trajectory of cognitive impairment. Results: Cognitive functioning significantly declined by 2.8 points by 4 years post stroke. Eighty-four percent of stroke survivors had cognitive impairment indicative of post-stroke dementia (mean Montreal cognitive assessment = 20 ± 4.7) at 4-year. There were significant as­sociations between progressive cognitive decline and the ­following factors: male gender (OR 2.9, 95% CI 1.6–5.9, ­p = 0.0171), coronary artery disease (OR 2.96, 95% CI 1.35–6.49, p = 0.0070), arrhythmia (OR 2.21, 95% CI 1.07–4.57, p = 0.0317), not in a relationship (OR 2.8, 95% CI 1.4–5.50, p < 0.0001), and not employed (OR 4.9, 95% CI 1.9–12.1, p < 0.0001). Conclusions: Cognitive deficits remain highly prevalent at 4-year post stroke. Early identification of those at higher risk of declining cognition is vital to target rehabilitation interventions at the acute stage and improve overall outcomes.

Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

“…In addition, patients with PSCI were vulnerable to experience poor functional outcome, high recurrence of stroke, reduced quality of life, and high rates of mortality . Multiple factors have been implicated to be correlated with an increased risk of cognitive impairment, including vascular comorbidities, stroke location, depression, sleep disturbance, and demographic characteristics (eg, older age, female, and lower education levels) . However, it is still crucial to find more modifiable risk factors that underlies the pathophysiology of PSCI.…”

Poststroke cognitive impairment

“…Полученные данные согласуются с рядом других исследований, в которых также отмечалось ухудшение когнитивных функций после перенесенного инсульта. Наблюдение пациентов, перенесших инсульт, в Новой Зеландии [32] через 2 года с момента инсульта показало снижение когнитивных функций по Монреальской шкале когнитивных функций на 2,8 балла по сравнению с результатами в начале исследования, а через 4 года у 84% пациентов определялись КН.…”

Post-stroke cognitive impairment (results of a 5-year follow-up)

“…Полученные данные согласуются с ре-зультатами ряда других исследований, в которых также на-блюдалось ухудшение когнитивных функций у пациентов после инсульта; у больных, у которых с момента развития инсульта прошло от 3 мес до 20 лет, показана высокая часто-та развития деменции -от 6 до 32% [24]. Аналогичные ре-зультаты получены в недавнем исследовании, проведенном в Новой Зеландии [25]. В ходе 4-летнего наблюдения за па-циентами выявлено прогрессирование КН: через 2 года по-сле возникновения инсульта установлено снижение когни-тивных функций по монреальской шкале оценки когнитив-ных функций (MoCA) на 2,8 балла по сравнению с результа-тами в начале исследования, а через 4 года у 84% пациентов определялись КН (средний балл по MoCA -20±4,7).…”