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What Is the Impact of Poststroke Cognitive Impairment in Patients With Mild Stroke?

Approximately half of patients who survive mild stroke have cognitive impairment.


 

LOS ANGELES—Poststroke cognitive impairment is associated with inability to return to work and to drive, according to research presented at the International Stroke Conference 2018. Patients who are able to return to work appear to have higher Montreal Cognitive Assessment (MOCA) scores. In addition, factors such as being older than 65, having a history of stroke and diabetes, being unemployed, and living in a facility may suggest a higher risk of poststroke cognitive impairment, the authors noted.

Since cognitive impairment can impact life quality, screening, even in mild stroke, could be beneficial,” said Ilavarasy Maran, MD, a resident at the University of Connecticut Health/Hartford Hospital.

Ilavarasy Maran, MD

Two of the main causes of dependency in stroke survivors are poststroke cognitive impairment and poststroke dementia. Approximately two-thirds of patients with stroke develop cognitive decline. This prevalence is expected to rise because of the aging population, said the researchers.

To evaluate the burden and risk factors associated with cognitive impairment after mild stroke, Dr. Maran and colleagues conducted a retrospective observational cohort study of 56 patients (51 with ischemic stroke, five with hemorrhagic stroke) evaluated between July 2016 and June 2017. Patients completed a questionnaire that elicited demographic information and history, as well as previously known cognitive impairment. Researchers used MOCA to evaluate cognition.

Median age was 61.5, 66.1% of patients were men, 76.8% were Caucasian, and the median discharge NIH Stroke Scale score was 1. Four percent of patients presented to the clinic at fewer than six weeks, 71.4% presented to the clinic at six to 12 weeks, 17.9% presented to the clinic at 12 to 24 weeks, and 7.1% of patients presented to the clinic at more than 24 weeks after discharge for stroke. None of the patients had a previous history of dementia, said the researchers.

In all, 50% of patients had no cognitive impairment, 19.6% had mild impairment, 16.1% had moderate impairment, and 14.3% had dementia. In addition, 50% of patients who had been working previously were able to return to work. This group had higher MOCA scores than did participants who did not return to work. Approximately 19.6% of patients who stopped driving did so due to cognitive impairment. No significant difference in MOCA scores based on the location of the stroke was reported.

Researchers also observed that patients with cognitive impairment had a previous history of hypertension and that history of depression did not appear to influence poststroke cognitive impairment.

—Erica Tricarico

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