Neuropsychological Profiles of 5-Year Ischemic Stroke Survivors by Oxfordshire Stroke Classification and Hemisphere of Lesion

Abstract

Background and Purpose-Although the neuropsychological literature typically examines stroke outcomes by hemisphere of lesion, the medical literature provides classifications more closely linked to circulatory distribution impacted by stroke. This article examined profiles of cognitive function by hemisphere and by Oxfordshire Community Stroke Project stroke classification. Methods-This study included a sample of 315 5-year ischemic stroke survivors. Assessment included tests of verbal memory, visual memory, word finding/verbal fluency, abstract visual reasoning, executive functioning, and speed of processing. Results-The sample produced scores within 1 standard deviation of the normative mean on tests of abstract visual reasoning, verbal memory, and visual recall. Impaired performances were observed for executive function and processing speed. Profile analysis revealed no significant differences in overall cognitive performance or in the profile of performance across measures by hemisphere of lesion. However, groups defined by Oxfordshire Community Stroke Project categories produced significantly different cognitive profiles. Post hoc analyses indicate those with posterior stroke performed best overall on all tests except the Stroop Dots trial, whereas those with total anterior stroke produced significantly worse scores on tasks requiring visual abstract reasoning (Block Design, Rey Figure Copy), word finding (Boston Naming Test), and processing speed (Stroop Dots, Trails A). Conclusions-Oxfordshire Community Stroke Project stroke subtypes identified significant differences between groups, suggesting this classification system is of greater use than hemisphere of lesion in predicting poststroke cognitive outcomes. (Stroke. 2012;43:50-55.)

Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes

“…Nineteen studies compared lacunar with non-lacunar stroke9–29 35 36 (79% of studies, 95% of subjects), three studies30 32 33 compared lacunar stroke with healthy volunteers and two had no control group. Median study size was 170 patients (range 30–3201) and mean age of the patients was 73 years (we were not able to calculate median age).…”

“…Seventeen studies9–17 19–25 27 29 30 35 36 reported the number of subjects in whom testing was attempted (9154 patients) and the number that completed the tests (7401 patients); eight9–12 14 16 17 24 27 36 studies reported the combined number of attempted and successful tests in patients with ischaemic and haemorrhagic stroke, but not the values for ischaemic stroke alone; and seven studies18 25 26 29 31 34 35 reported cognitive outcomes for 155 patients who only completed some of the assessments. Two studies 12 30 excluded patients with depression (8% of studies, 2% of patients); one study10 measured premorbid IQ using the National Adult Reading Test but did not account for it in the analysis (4% of studies, 3% of patients); and nine studies9–11 15 18 24 26 27 30 interviewed relatives about signs of cognitive decline prior to the index stroke (38% of studies, 19% of patients).…”

“…The remaining studies either performed a mixture of CT and MRI scans or did not give imaging details. Nine studies12 16 26 29 31 32 28 33 35 used a risk factor free clinical classification (eg, OCSP5) to categorise subjects as ‘lacunar’ or ‘non-lacunar’ stroke (38% of studies, 23% of patients). Nine studies10 13–15 18 23 27 34 36 used the risk factor based TOAST classification (38% of studies, 66% of patients).…”

“…Sixteen studies9–12 14 15 18 21 23 25–28 32 34 35 performed detailed cognitive testing of all cognitive domains (67% of studies, 72% of patients). Six studies16 24 29 31 33 36 used only the MMSE (25% of studies, 18% of patients).…”

The effect of physical training on glutamate transporter expression in an experimental ischemic stroke rat model

“…Stroke is a major cause of morbidity and mortality around the world, and there is an association between age and the risk of stroke [1]. Ischemic strokes, accounting for 80% of all strokes may be caused due to atherosclerotic disease, embolism, hypercoagulable disorders, and in certain cases, due to undetermined causes [2].…”