Predictors of dementia after first ischemic stroke

El-Sheik, Wafik M.; El-Emam, Aktham Ismail; El-Rahman, Ahmed Abd El-Galil Abd; Salim, Gelan Mahmoud

doi:10.1590/1980-57642021dn15-020009

Cited by 5 publications

(3 citation statements)

References 42 publications

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“…Our univariate analysis found that age > 60-years was associated with post stroke cognitive impairment, consistent with prior studies in other populations [ 22 ]. In contrast to some other studies [ 34 , 35 ], we found no associations between MCI and the independent variables of sex and stroke severity (as measured by NIHSS scores). The lack of associations may be related to the timing of our assessments, the type of cognitive assessments, and differences in educational attainment between study populations.…”

Section: Discussioncontrasting

confidence: 99%

Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda

Kaddumukasa

Katabira

et al. 2023

BMC Neurol

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Background Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda’s Mulago Hospital, located in sub-Saharan Africa. Methods 131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants’ cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0–28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25–8.33; p = 0.016), functional handicap (mRS 3–5; OR 1.84, 95% CI 1.28–2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14–6.56; p = 0.024) were independently associated with cognitive impairment. Conclusions Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.

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Section: Discussioncontrasting

confidence: 99%

Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda

Kaddumukasa

Katabira

et al. 2023

BMC Neurol

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“…Our univariate analysis found that age > 60-years was associated with post stroke cognitive impairment, consistent with prior studies in other populations (20). In contrast to some other studies (33,34), we found no associations between sex and stroke severity (as measured by NIHSS scores) with MCI. The lack of associations may be related to the timing of our assessments, the type of cognitive assessments, and differences in educational attainment between study populations.…”

Section: Discussionsupporting

confidence: 89%

Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda

Kaddumukasa

Katabira

et al. 2023

Preprint

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Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda’s Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants’ cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0–28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25–8.33; p = 0.016), functional handicap (mRS 3–5; OR 1.84, 95% CI 1.28–2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14–6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.

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“…While we found that no singular comorbid condition was associated with post-stroke cognitive decline, as measured by MoCA or MMSE, the total scores were associated with cognitive decline and, therefore, may be indicative of a cumulative, rather than singular, burden. This is not an entirely novel finding in the literature [ 24 , 25 ]; however, the perspective in the literature, when it comes to correlations between disease states and cognitive function, is quite narrow. For example, studies often illustrate the differences in cognitive outcomes, depending on singular inflammatory conditions, such as diabetes [ 26 ], metabolic syndrome [ 27 ], obstructive sleep apnea [ 28 ], and hypertension [ 14 , 29 ], rather than a collective burden of multiple comorbid conditions.…”

Section: Discussionmentioning

confidence: 73%

Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors

Morrison

White

Rothers

et al. 2022

IJERPH

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A considerable complication for stroke survivors is the subsequent development of cognitive decline or dementia. In this study, the relationship between the inflammation-centered comorbidity burden on post-stroke cognitive function among community-dwelling stroke survivors capable of independent living was examined. Data for this secondary analysis were collected from stroke survivors (n = 97) participating in a randomized clinical trial. Participants provided baseline responses, regarding cognitive function (mini-mental status exam, MMSE; Montreal cognitive assessment, MoCA), history of stroke comorbid conditions, and the Stroke Prognosis Instrument-II (SPI-II), an index of stroke comorbidity and recurrent stroke risk within the next two years. Relationships and differences between groups were tested for significance using Spearman’s correlation, Kruskal–Wallis, or Mann–Whitney U tests. Most stroke survivors (69%) had multiple comorbidities. Total SPI-II scores were negatively correlated to both MoCA and MMSE scores (r = −0.25, p = 0.01; r = −0.22, p = 0.03, respectively), and differences in MoCA scores among SPI-II risk groups (low, medium, high) were evident (p = 0.05). In contrast, there were no differences in MoCA or MMSE scores when comorbid conditions were examined individually. Lastly, no gender differences were evident in cognitive assessments. Our data support the premise that comorbidity’s burden impacts post-stroke cognitive decline, more than a single comorbid condition. Inflammation may be an important component of this comorbidity burden. Future studies that operationalize this concept will better illuminate the complex phenomenon of post-stroke cognitive decline for improved clinical rehabilitation modalities.

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Predictors of dementia after first ischemic stroke

Cited by 5 publications

References 42 publications

Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda

Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda

Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda

Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors

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