New Onset Poststroke Dementia at one Year in Africans

Abstract

Background: There is limited information on new onset poststroke dementia (NPSD) in sub-Saharan Africa (SSA). We estimated incidence, cumulative incidence, risk factors and outcome of NPSD at 1 year in Nigerian survivors of a first-ever stroke. Methods: Hospital-based prospective observational study. Assessments for global cognition, learning, memory, executive and activities of daily life (ADL) functioning were conducted at 3 poststroke timepoints (Baseline, 3- and 12 months). NPSD was ascertained according to the “National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) criteria.” Outcomes were assessed using the modified Rankin Scale (mRS), center for epidemiologic studies depression scale (CES-D 10), health related quality of life in stroke patients (HRQOLISP-26) and caregivers strain index (CSI). Results: Among 144 stroke survivors who were free of dementia at baseline, we found a 1-year cumulative incidence of 4.52% (95% C.I = 3.20, 6.39). In multivariate Cox regression analyses, diabetes was associated with NPSD (Hazard Ratio = 2.10, 95% CI = 1.02, 4.35). NPSD at 3 months was independently associated with motor decline [Mean difference (MD) in mRS = 1.6, 95% C.I = 0.9, 2.3)], depression (MD in CES-D = 2.9, 95% C.I = 0.3, 5.4), caregivers burden (MD in CSI = 1.2, 95% C.I = 0.5, 1.8), and poor quality of life (MD in HRQOLISP-26 = −11.2, 95% C.I = −15.7, −6.8) at 1 year. Conclusion: Approximately 4.5% of stroke survivors in Nigeria had NPSD at 1 year. Diabetes, which can be prevented, represent a primary prevention target for NPSD and its consequences in SSA.

Association of socioeconomic status and poststroke cognitive function: A systematic review and meta‐analysis

“…Besides, removal of four studies with HR as the outcome did not change the significance of the result (OR = 2.13, 95% CI = 1.4-3.23, I 2 = 73.6%). 44,51,53,55 As showed in Figure 7…”

“…A total of 17 studies provided data on stroke severity on admission, 13 of which were assessed using the National Institutes of Health Stroke Scale. 26,27,29,30,[34][35][36][37][38][39][40][41][42] Fourteen studies only enrolled participants who experienced their first-time stroke, 12,28,31,34,36,39,40,[42][43][44][45][46][47][48] and 16 studies included participants with stroke history. [24][25][26][27]29,32,33,37,38,41,[49][50][51][52][53][54] Two studies did not restrict the stroke history of the participants, but they also provided another set of data specific to first-time stroke patients.…”

“…33,45,52,54,55 On account of the cognitive outcomes, a total of 19 studies provided data on PSCI as the outcome, 12,27,28,[33][34][35][36][37][38][39][40]42,43,45,46,[48][49][50]52 13 reported PSD as the outcome. [24][25][26]29,30,32,41,44,47,51,[53][54][55] One study reported both PSCI and PSD. 31 Boutros et al utilized both mild cognitive impairment and severe cognitive impairment as the outcomes.…”

“…One study measured economic status by assets based measures. 44 Considering the small number of studies with comprehensive SES and economic status, these studies were removed from subgroup analysis stratified by SES indicators. Most of the research presented results derived from adjusted models.…”

“…Premorbid cognitive impairment and dementia were screened in most studies. Twenty-eight studies excluded patients with pre-stroke cognitive impairment or dementia, 12,[23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][46][47][48]50,51,53 either by medical history or by certain cognitive tests. One study provided the incidence of pre-stroke cognitive impairment.…”