Cognitive Impairment, Vulnerability, and Mortality Post Ischemic Stroke: A Five-Year Follow-Up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Cohort

Gaynor, Eva; Rohde, Daniela; Large, Margaret; Mellon, Lisa; Hall, Patricia; Brewer, Linda; Conway, Orla; Hickey, Anne; Bennett, Kathleen; Callaly, Elizabeth; Williams, David

doi:10.1016/j.jstrokecerebrovasdis.2018.05.002

Cited by 23 publications

(19 citation statements)

References 41 publications

(40 reference statements)

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“…1,2 Research and interventions have historically mainly focused on physical disabilities, but more and more evidence suggests that cognitive impairment (CI) is closely related to the prognosis of stroke patients. [3][4][5] Poststroke cognitive impairment (PSCI) may reduce the quality of life, and increase the risk of stroke recurrence. 6 It cast a heavy economic burden to families and the society.…”

Section: Introductionmentioning

confidence: 99%

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

Liao¹,

Zuo²,

Zhang³

et al. 2020

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Section: Introductionmentioning

confidence: 99%

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

Liao¹,

Zuo²,

Zhang³

et al. 2020

NDT

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“…There were a number of limitations. We previously reported that stroke survivors with cognitive impairment at six months post-stroke were more likely to have died within the follow-up period [20]. Additionally, stroke survivors who were lost to the 5-year ASPIRE-S follow-up were more likely to be older, female, and to have evidence of cognitive impairment and moderate to severe disability at 6 months post-stroke [9], suggesting that the prevalence of cognitive impairment reported here is likely to be underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…This study involved a five-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) observational cohort study, which recruited acute ischemic stroke survivors in hospital and followed them up in the community six months later [17, 18]. The design and methods of this five-year follow-up have been described previously [19, 20].…”

Section: Methodsmentioning

confidence: 99%

Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort

et al. 2019

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BackgroundControl of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke.MethodsA five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data.ResultsThe prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)].ConclusionsThis is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.

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“…EQ-5D-5L+C of life, 16 more severe disabilities, 17 mortality 18 and mood problems in the long term after stroke. 19 Therefore, early detection of cognitive problems after stroke is of great importance.…”

Section: Eq-5d-5lmentioning

confidence: 99%

Validity of an enhanced EQ-5D-5L measure with an added cognitive dimension in patients with stroke

et al. 2020

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Objective: The 5-level EuroQoL (EQ-5D-5L) is a patient-reported outcome measure frequently used in stroke research. However, it does not assess the cognitive problems many patients with stroke experience. The aim of this article is to compare the content validity, internal consistency and discriminative ability of the EQ-5D-5L with and without an additional cognitive domain (EQ-5D-5L+C), administered three months post-stroke. Design: Cross-sectional study. Setting: Six general hospitals in the Netherlands. Subjects: In all, 360 individuals with stroke three months after the event. Interventions: Not applicable. Main measures: The modified Rankin Scale and EQ-5D-5L+C were administered in telephone interviews three months post-stroke. Results: A total of 360 patients with stroke were included. Mean age was 68.8 years (standard deviation (SD) = 11.7), 143 (40%) were female, 334 (93%) had had an ischemic stroke, 165 (46%) had a National Institutes of Health Stroke Scale (NIHSS) score ⩽ 4 at presentation and the Barthel Index was 17.2 (SD = 4) four days post-stroke. Cognitive problems were reported by 199 (55%) patients three months post-stroke. Internal consistencies of the EQ-5D-5L and EQ-5D-5L+C were 0.75 and 0.77, respectively. Adding a cognitive domain resulted in a decrease of the ceiling effect from 22% to 14%. Both EQ-5D-5L and EQ-5D-5L+C showed good discriminative ability, but differences between patients with different modified Rankin Scale scores and with/without reported decrease in health and daily activities were slightly larger with the EQ-5D-5L+C compared to the EQ-5D-5L. Conclusions: The EQ-5D-5L+C, which includes a cognitive domain that is highly significant for stroke patients, showed increased content validity and good discriminative ability, without losing internal consistency.

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Cognitive Impairment, Vulnerability, and Mortality Post Ischemic Stroke: A Five-Year Follow-Up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Cohort

Cited by 23 publications

References 41 publications

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

<p>The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke</p>

Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort

Validity of an enhanced EQ-5D-5L measure with an added cognitive dimension in patients with stroke

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