Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study

Abstract

BackgroundCognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. The aim of this study was to profile cognitive impairment of stroke survivors at six months, and to identify factors associated with cognitive impairment post-stroke, focusing on indicators of adequate secondary prevention and psychological function.MethodsParticipants were assessed at six months following an ischaemic stroke as part of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke study (ASPIRE-S), which examined the secondary preventive and rehabilitative profile of patients in the community post-stroke. Cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA).ResultsTwo-hundred and fifty-six stroke patients were assessed at six months. Over half of the sample (56.6%) were found to have cognitive impairment, with significant associations between cognitive impairment and female sex (odds ratio (OR) = 1.6, 95% CI 1.01-2.57) and history of cerebrovascular disease (OR = 2.22, 95% CI 1.38-3.59). Treatment with antihypertensive medications (OR = .65, 95% CI .44-.96) and prescription of anticoagulant therapy (OR = .41, 95% CI .26-.68) were associated with reduced likelihood of cognitive impairment, however increasing number of total prescribed medications was moderately associated with poorer cognitive impairment (OR = 1.12, 95% CI 1.04-1.19).ConclusionsFindings reveal levels of cognitive impairment at 6 months post-stroke that are concerning. Encouragingly, aspects of secondary prevention were identified that may be protective in reducing the incidence of cognitive impairment post-stroke. Neuropsychological rehabilitation post-stroke is also required as part of stroke rehabilitation models to meet the burden of post-stroke cognitive impairment.

Risk factors associated with post-stroke dementia: a systematic review and meta-analysis

“…According to the result of this study, it was found that the memory disturbance between 20 -80 percentage 7,8 and the incidence of dementia after stroking was 5 -48%. 3,4,[11][12][13][14][15][16] Moreover, the incident of dementia after recurrent stroke was 33.33 %.…”

“…4 From the previous study that traced patients with stroke during three months it was found that most patients have mild disability (57.2%), some have severe disability (18.6%), and a few have moderate disability (9.4%). 5 In addition, stroke also led to memory disturbance and dementia over 9.4 times compared with and without stroke, 6 memory disturbance between 20 -80 percentage, 7,8 and the incidence of dementia was 5-48 percentage. 3,4 Moreover, probability of recurrent stroke increased, 9,10 recurrent stroke was 33.3 percentage, 11 the mortality rate of dementia after stroking was three times compared with and without, 7 and the estimated cost of caring the dementia patients around the world is approximately 604,000 million US dollar.…”

Cuidado popular de familias con un adulto mayor sobreviviente del primer accidente cerebrovascular

“…Sin embargo, la evidencia cualitativa sobre la experiencia de sobrevivientes de ACV señala la necesidad de considerar, para la atención, categorías relacionadas con la interrupción biográfica (cambio, transición, transformación), las pérdidas, el aislamiento social, la adaptación y la reconciliación, más que sobre la enfermedad en sí misma, e invitan a no dejar de lado la discapacidad residual neurológica del sobreviviente de ACV y señalan cómo una revisión sistemática con metaanálisis demostró que el 10 % de pacientes pueden desarrollar demencia en el año posterior al primer ACV (3,18,19).…”

“…Quienes sobreviven al ACV pueden padecer discapacidad física o cognitiva, problemas visuales, problemas de comunicación, disminución de la sensibilidad, pérdida de la conciencia de una parte de su cuerpo, limitación en las actividades con secuelas por varios años (3,4). Después de la fase aguda, los sobrevivientes regresan a casa con importantes limitaciones.…”

Therapy of poststroke cognitive impairment

“…Из 256 пациентов больше чем у половины (у 56,6%) обнаружены когнитивные нарушения различной степени выраженности, при этом лечение антигипертензивными препаратами и антикоагулянтная терапия были связаны с уменьшением риска развития когнитивных нарушений [23]. Важным является и кон-троль других наиболее значимых факторов риска: сер-дечно-сосудистой патологии, сахарного диабета, гипер-липидемии, гипергомоцистеинемии.…”