Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study

Abstract

Aim. To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI). Methods. We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data. Results. 325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function. Discussion and Conclusion. Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities.

The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

“…Examining the association between psychiatric symptoms and performance-based function, we found that higher levels of anxiety and phobic anxiety were associated with poorer cognitive function. This differs from earlier work, which did not find a relation between anxiety and cognition 12 months after a minor stroke (Morsund et al, 2019). Inconsistent results might be due to the time of assessment, as anxiety is less prevalent 6-12 months post-stroke compared to the first 6 months (Knapp et al, 2020).…”

“…Higher levels of depressive symptoms were associated with lower performance-based memory but not with attention/ executive function. Cognitive impairments and depression are highly prevalent after minor stroke (Moran et al, 2014), and several studies have found an association between symptoms of depression and cognitive domains such as verbal memory, cognitive speed (Barker-Collo, 2007), and executive function (Morsund et al, 2019). Our study extends these findings to patients with good outcomes after stroke.…”

“…Here, depression has typically been associated with poorer performancebased cognitive function post-stroke Robinson & Jorge, 2016). This relationship between depressive symptoms and poorer cognitive function was also found in patients with minor stroke who have relatively good general outcomes and a promising long-term prognosis (Morsund et al, 2019). The association between anxiety and performance-based cognitive function seems to be less clear, and contradictory findings exist (Grosdemange et al, 2015;Morsund et al, 2019).…”

The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study

“…Lacking a stroke-free control group, we were unable to evaluate whether cognition is more severely impaired in those who have suffered a stroke than in the background population. A recent study found no differences in cognitive function between patients with minor stroke and those with myocardial infarction 1 year after the vascular event ( 36 ). Additionally, in our study population comprising both first-ever and recurrent strokes, an evaluation of the effects of recurrent strokes is limited.…”

Neuropsychiatric Complications after Stroke

“…8,10,47 Greater stroke severity has also been associated with increased risk of PSD, though this relationship may be mediated by degree of disability. 8,47 Cognitive impairment appears to be a risk factor for PSD, 8,47,53,54 with greater executive dysfunction associated with worse depression outcomes. 55 A proposed association between lesion location, laterality, and PSD has been the subject of extensive debate, with early studies by Robinson and colleagues suggesting a link between left hemisphere (especially left frontal) lesions and subsequent depression.…”