Essentials Cognitive impairment is frequent after stroke and knowledge on predictors is limited.We investigated hemostatic biomarkers as predictors of long‐term cognitive function after stroke.Fibrinogen, von Willebrand factor and tissue‐type plasminogen activator correlated to cognitive outcome.In young patients, fibrinogen was independently associated to worse cognitive outcome 7 years post‐stroke. BackgroundCognitive impairment is frequent after stroke, and young patients may live with this consequence for a long time. Predictors of cognitive outcomes after stroke represent a current gap of knowledge.ObjectivesTo investigate levels of three hemostatic biomarkers as predictors of long‐term cognitive function after stroke.MethodsThis longitudinal study included consecutively recruited patients with ischemic stroke at 18‐69 years (n = 268). Blood was collected 3 months after index stroke and analyzed for plasma concentrations of fibrinogen, von Willebrand factor (VWF) and tissue‐type plasminogen activator (t‐PA) antigen. Cognitive function 7 years after index stroke was assessed by the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Participants with stroke <50 years of age were also examined by the Trail Making Test A and B (n = 41). Associations between biomarker concentrations and cognitive scales were assessed in the whole group and in participants with stroke <50 years of age.ResultsThe hemostatic biomarkers fibrinogen, VWF and t‐PA, were all correlated to total BNIS score, but these associations did not withstand adjustment for confounding factors in the whole group. However, in patients <50 years, we found an independent association between fibrinogen concentrations and total BNIS score (βstd = −.27, 95% confidence interval [CI], −0.47 to −0.07) and to performance on the Trail Making Test A (βstd = .31, 95% CI, 0.03–0.58). No such association was seen for the Trail Making Test B.ConclusionHigh convalescent fibrinogen concentrations were associated with worse long‐term cognitive outcomes in ischemic stroke <50 years of age. We propose further investigations of fibrinogen in relation to cognitive function in stroke in the young.

Background and purpose This cross‐sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post‐stroke in order to analyze the relation between late cognitive ability and employment. Methods Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long‐term follow‐up 7 years post‐stroke were included. At this follow‐up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self‐reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. Results Seven years post‐stroke 112/142 (79%) had part‐time or full‐time work and 30/142 (21%) had full‐time disability pension or sick leave. Compared to those with full‐time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self‐ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self‐rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61–4.21), processing speed (OR 3.50, 95% CI 1.67–7.33) and self‐rated communication skills (OR 3.46, 95% CI 1.75–6.85) as most important correlates (area under the curve 0.83–0.87) of having current employment. Conclusion This study indicates that cognitive dysfunction is an important contributor to long‐term work disability amongst young stroke survivors with good physical recovery.

Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.

Background and purpose: Visuospatial inattention (VSI) and language impairment (LI) are often present early after stroke and associations with an unfavorable short-term functional outcome have been reported. The purpose of this study was to investigate whether a screening of VSI and LI as indicators of cortical symptoms early after stroke could predict long-term functional outcomes. Methods: A consecutive cohort of 375 patients with ischemic stroke was assessed for the occurrence of VSI at a median of 7 days after admission (interquartile range, 1-5 days) using the Star Cancellation Test and for LI (within the first 7 days) with the language item in the Scandinavian Stroke Scale. Seven years later, functional outcomes were assessed by the modified Rankin scale and Frenchay Activities Index in 235 survivors without recurrent stroke. Relationships between baseline predictors and functional outcome at 7 years were analyzed with bivariate correlations and multiple categorical regressions with optimal scaling. Results: The regression model significantly explained variance in the modified Rankin scale (R 2 = 0.435, P < 0.001) and identified VSI (P = 0.001) and neurological deficits (P < 0.001; Scandinavian Stroke Scale score without the language item) as the significant independent predictors. The model for Frenchay Activities Index was also significant (R 2 = 0.269, P < 0.001) with VSI (P = 0.035) and neurological deficits (P < 0.001) as significant independent predictors. Conclusions: Visuospatial inattention at acute stroke has an independent impact on long-term functional outcomes. Early recognition may enable targeted rehabilitative interventions.

Objective Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long‐term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. Methods From a cohort of acute ischemic stroke patients, aged 18‐69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow‐up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star‐ and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7‐year follow‐up was investigated with the Star‐ and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. Results At the follow‐up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P < .001) and inferior baseline performance on visual processing speed (P = .008). Conclusion About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research.