Effect of Age at Pediatric Stroke on Long-term Cognitive Outcome

Abstract

Objectives:To investigate the impact of age at pediatric arterial ischemic stroke on long-term cognitive outcome in order to identify patients particularly at risk for the development of cognitive long-term cognitive sequelae.Methods:This cross-sectional study included patients in the chronic phase of stroke (> 2 years after stroke) previously diagnosed with neonatal or childhood arterial ischemic stroke and a control group. Participants with active epilepsy, severe learning difficulties, or behavioral problems hindering the cognitive assessment were excluded. Several cognitive domains, including intelligence, executive functions (working memory, inhibition, and cognitive flexibility), processing speed, memory, letter fluency, and visual-motor skills were assessed with neuropsychological tests. Cognitive long-term outcome was compared across patients after neonatal stroke (stroke between 0 and 28 days of life), early childhood stroke (stroke between 29 days and < 6 years) and late childhood stroke (stroke between ≥ 6 and < 16 years).Results:52 patients after neonatal or childhood arterial ischemic stroke (median age: 15.3 years, IQR = 10.6 – 18.7) and 49 healthy controls (median age: 13.6 years, IQR = 9.8 – 17.2) met the inclusion criteria. Cognitive outcome was significantly worse in the pediatric stroke group compared to the control group. A non-linear effect of age at stroke (irrespective of lesion size and lesion location) was found for cognitive flexibility, processing speed, and verbal learning with early childhood stroke (29 days to < 6 years) showing significantly worse cognitive outcome compared to neonatal or late childhood stroke (p < .05, FDR-corrected).Conclusion:Age at stroke is an important factor for post-stroke recovery and modulates long-term cognitive outcome irrespective of lesion size and lesion location. Children after early childhood stroke are at particular risk for alterations of long-term cognitive functions.

Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury

“…The cognitive domains that are the most severely disrupted by pediatric brain injury include executive functioning, processing speed, attention, and, to a lesser degree, verbal memory, fluency, and planning and problem solving [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Broadly, executive functions are the skills necessary to regulate thoughts, behaviors, and emotions and include skills such as impulse control, self-monitoring, behavioral and emotional modulation, task initiation and completion, problem-solving, and cognitive flexibility.…”

“…Broadly, executive functions are the skills necessary to regulate thoughts, behaviors, and emotions and include skills such as impulse control, self-monitoring, behavioral and emotional modulation, task initiation and completion, problem-solving, and cognitive flexibility. In children with brain injuries, executive difficulties are generally most pronounced in the areas of cognitive flexibility and inhibition [ 24 , 34 , 35 ]. Critically, due to the protracted nature of brain development, long-term executive functioning sequelae may not become apparent until adolescence [ 36 ].…”

“…Similar to TBI, injury severity and age of injury are predictive of cognitive recovery in childhood stroke. Childhood stroke survivors are at greatest risk for long-term cognitive sequelae if their stroke was more severe [ 40 ] or occurred very early in life, particularly between 29 days and six years of age [ 24 , 41 ]. Further, risk is increased if one develops post-stroke seizures [ 41 ].…”

Evaluation of stroke health education for primary school students in Dali, China

“…The rapid changes in lifestyle and dietary habits have made younger people more vulnerable to stroke in recent years ( 5 ). Children who had experienced early childhood stroke were at particular risk of alterations in cognitive functions ( 6 ). Moreover, epidemiological evidence of stroke burden among Dali residents was lacking.…”

How Plastic Are Children?

“…Many studies exclude children with epilepsy or major behavior problems. 3,5 While only 11 children in the current study were excluded due to active epilepsy, pronounced behavioral problems, or severe learning difficulties (eFigure 1), 191 children did not respond or declined participation, 3 raising the possibility that parents who thought that their child may have difficulty with the testing were more likely to decline participation or to be nonrespondents. Furthermore, more than 100 children were too young to test at the time of the study.…”