Baseline Function and Rehabilitation Are as Important as Stroke Severity as Long-term Predictors of Cognitive Performance Post-stroke

Abstract

Objective: Although individuals with low stroke severity tend to recover well, cognitive impairment is common independent of stroke size or location. In this study, the patterns of recovery for individual cognitive domains and factors associated with outcome were examined. Design: A prospectively enrolled cohort of patients with minor stroke was administered cognitive testing at 1, 6, and 12 mos postinfarct. Composite T scores were generated for global cognition and well as independent cognitive domains at each time point. Paired t tests compared changes in scores over time. Regression models identified factors associated with improvement. Results: A total of 46 patients, with an average NIH Stroke Scale score of 2.7, were enrolled. Average age was 61.3 yrs. Patients improved overall between 1 and 6 mos; however, distinct patterns of recovery were seen for different cognitive domains. The most significant improvement was in spatial memory. Verbal memory scores remained low longitudinally. Motor speed and executive function increased, then plateaued. Despite a mean education of 13.6 yrs, only 36% of global cognition scores were higher than or equal to the normative mean at 12 mos, and only 57% of patients improved their global scores from 6 to 12 mos. Late recovery was associated with lower NIH Stroke Scale scores, higher 1-mo Montreal Cognitive Assessment scores, and rehabilitation. Baseline function predicted overall long-term recovery. Conclusion: Patterns of recovery are distinct for individual cognitive domains for patients with minor stroke. Stroke severity and rehabilitation influence trajectory. Premorbid baseline predicts long-term outcome.

Risk factors for post-stroke depression in patients with mild and moderate strokes

“…A previous study showed that cognitive function might be transiently impaired in patients with an acute stroke, and improved after rehabilitation. [36,37] Thus, the cognitive deficits might be a prominent feature in acute stroke.…”

Poststroke Cognitive Decline: Is Functional Connectivity the Key to Tangible Therapeutic Targets?

“…As the treatment of patients with large vessel occlusions has advanced over time resulting in smaller strokes and better long-term language and motor outcomes, cognitive impairment has been increasingly recognized as a significant factor that impacts overall function and quality of life. 2 Poststroke cognitive impairment represents a spectrum of phenotypes. It has been reported to occur in up to 60% to 70% of patients after a stroke.…”

“…Unfortunately, improvement can be short-lived, with up to half developing a recurrence of deficits leading to disability over the next 2 to 5 years. 2,3 Based on previous literature, it follows that the patterns of functional connectivity responsible for recovery are likely initially similar between groups but then diverge to result in varied long-term outcomes. 24 Further evidence, along with the ability to predict who is at greatest risk based on their connectivity profiles during early recovery, would allow not only for improved prognostication but also for the ability to potentially modify a patient’s trajectory based on a tangible therapeutic target.…”

“…Unlike patients with Alzheimer disease, who experience a slow, steady decline, impairment can be seen acutely, 4,5 then improve as a patient recovers, only to worsen again 1 to 2 years later at higher rates than would be expected in the general population. 2,5 In addition, patterns of recovery and decline are inconsistent, which has made characterizing poststroke dementia and its associated factors challenging. Consensus regarding the key features for diagnosis is critical, and studies are currently underway to better understand the pathophysiology and identify risk factors to inform the most effective potential treatment strategies.…”

“…As the treatment of patients with large vessel occlusions has advanced over time resulting in smaller strokes and better long-term language and motor outcomes, cognitive impairment has been increasingly recognized as a significant factor that impacts overall function and quality of life. 2…”