Progression of cognitive decline before and after incident stroke

Zheng, Feihu; Li, Yan; Zhong, Bao‐Liang; Yang, Zhenchun; Xie, Weixin

doi:10.1212/wnl.0000000000007716

Cited by 93 publications

(100 citation statements)

References 35 publications

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“…### LR χ 2 ( 8 ), Likelihood Ratio test model 1 vs. model 2 with 8 degrees of freedom; hypothesis test of whether there is an effect of stroke subtype. ***LR χ 2 ( 5 ), Likelihood Ratio test model 2 vs. model 3 with 5 degrees of freedom; hypothesis test of whether there is an effect of time for at least one stroke subtype. ‡ p < 0.01.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have reported conflicting results regarding the prognosis for patients suffering PSCI; these have indicated deterioration, no progression, and even improvement in cognition over time for subgroups (4)(5)(6)(7)(8)(9)(10)(11). Several cognitive domains are affected in PSCI; of these, impairment in attention and executive function seem to be the most prevalent and severe shortly after and a long time after suffering a stroke (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

et al. 2020

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Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51-0.66) and 0.51 (0.52-0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language Aam et al. Post-stroke Cognitive Impairment improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

et al. 2020

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“…In contrast to the increasingly recognized poststroke cognitive impairment (PSCI), which is increasingly recognized as associated with ischemic stroke (3), the incidence of cognitive dysfunction and the risk factors associated with the cognitive trajectory after ICH onset remain mostly unknown. This is likely due to the lower incidence of ICH and the high mortality rate observed during the acute stage (4)(5)(6). Indeed, ICH survivors are at high risk of cognitive decline following stroke onset, consequently affecting quality of life, and posing an increased social and economic burden.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Cognitive Recovery Beyond Early Poststroke Cognitive Impairment (PSCI): A Prospective Cohort Study of Spontaneous Intracerebral Hemorrhage

Gong

et al. 2020

Front. Neurol.

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Background: Poststroke cognitive impairment (PSCI) has been increasingly recognized in patients, but some stroke survivors appear to show cognitive improvement beyond the acute stage. The risk factors associated with cognitive recovery after spontaneous intracerebral hemorrhage (ICH) onset have not yet been sufficiently investigated in prospective studies. Objective: We aimed to identify the trajectory of post-ICH cognitive impairment and the association of potential prognostic factors with follow-up cognitive recovery beyond early PSCI. Methods: In this stroke center-based cohort study, 141 consecutive dementia-free patients with spontaneous ICH were included and underwent Montreal Cognitive Assessment (MoCA) evaluation for cognitive function at baseline (within 2 weeks of ICH onset) and the shortened MoCA (short-MoCA) at a 6-month follow-up. To explore the prognostic factors associated with trajectory of cognition after an ICH onset, we adjusted for demographic and vascular risk factors, using multivariate logistic regression analysis. Results: Of the 141 ICH patients, approximately three quarters (106/141) were diagnosed with early PSCI (MoCA score <26) within 2 weeks of ICH onset. The multiple logistic regression indicated independent positive associations between risk of early PSCI and dominant-hemisphere hemorrhage [odd's ratio (OR): 8.845 (3.347-23.371); P < 0.001], mean corpuscular volume (MCV) [OR: 1.079 (1.002-1.162); P = 0.043], admission systolic blood pressure (sBP) [OR: 1.021 (1.005-1.038); P = 0.012]. Furthermore, 36% (33/90) of ICH survivors who had early PSCI exhibited cognitive recovery at the 6-month follow-up. After examining potential predictors through multiple linear regression based on stepwise, there were independent negative associations between cognitive recovery and dominant hemisphere hemorrhage [OR: Gong et al. Cognitive Recovery of Hemorrhagic Stroke 6.955 (1.604-30.162); P < 0.01], lobar ICH [OR: 8.363 (1.479-47.290); P = 0.016], years of education ≤9 [OR: 5.145 (1.254-21.105); P = 0.023], and MCV [OR: 1.660 (1.171-2.354); P = 0.004]. Baseline cognitive performance in the domains of visuospatial/executive function, attention, orientation, and language showed positive correlations with cognitive improvement (P < 0.05). Conclusion: In this cohort study of dementia-free survivors of ICH, our results show that one in three early PSCI survivors exhibit cognitive recovery, in relation to dominant-hemisphere hematoma, lobar ICH, educational history, and MCV levels. Future clinical trials including ICH survivors with cognitive dysfunction should assess these factors.

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“…Cognitive impairment can develop acutely in the immediate aftermath of stroke with some degree of recovery expected over time. However, there is also a risk of a more chronic neurodegeneration as some, but not all, individuals can experience gradual and protracted cognitive decline in the years following stroke at a greater rate than would be expected from aging alone [6,7]. Consequently, there is an increasing incidence of dementia in the years following stroke [41].…”

Section: Discussionmentioning

confidence: 99%

“…Despite this initial recovery, cognitive impairment occurs at a high frequency, persisting well past the subacute recovery period [2,3]. Stroke places some individuals at risk of an increased rate of cognitive decline, even several years after stroke, and a history of stroke approximately doubles the long-term risk of incident dementia [2,[4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A longitudinal study of the post-stroke immune response and cognitive functioning: the StrokeCog study protocol

et al. 2020

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Background: Stroke increases the risk of cognitive impairment even several years after the stroke event. The exact mechanisms of post-stroke cognitive decline are unclear, but the immunological response to stroke might play a role. The aims of the StrokeCog study are to examine the associations between immunological responses and longterm post-stroke cognitive trajectories in individuals with ischemic stroke. Methods: StrokeCog is a single-center, prospective, observational, cohort study. Starting 6-12 months after stroke, comprehensive neuropsychological assessment, plasma and serum, and psychosocial variables will be collected at up to 4 annual visits. Single cell sequencing of peripheral blood monocytes and plasma proteomics will be conducted. The primary outcome will be the change in global and domain-specific neuropsychological performance across annual evaluations. To explain the differences in cognitive change amongst participants, we will examine the relationships between comprehensive immunological measures and these cognitive trajectories. It is anticipated that 210 participants will be enrolled during the first 3 years of this 4-year study. Accounting for attrition, an anticipated final sample size of 158 participants with an average of 3 annual study visits will be available at the completion of the study. Power analyses indicate that this sample size will provide 90% power to detect an average cognitive change of at least 0.23 standard deviations in either direction. Discussion: StrokeCog will provide novel insight into the relationships between immune events and cognitive change late after stroke.

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Progression of cognitive decline before and after incident stroke

Cited by 93 publications

References 35 publications

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

Prognostic Factors for Cognitive Recovery Beyond Early Poststroke Cognitive Impairment (PSCI): A Prospective Cohort Study of Spontaneous Intracerebral Hemorrhage

A longitudinal study of the post-stroke immune response and cognitive functioning: the StrokeCog study protocol

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