Impact of different methods defining post‐stroke neurocognitive disorder: The Nor‐COAST study

Munthe-Kaas, Ragnhild; Aam, Stina; Ihle‐Hansen, Hege; Lydersen, Stian; Knapskog, Anne Brita; Wyller, Torgeir Bruun; Fure, Brynjar; Thingstad, Pernille; Askim, Torunn; Beyer, Mona K.; Næss, Halvor; Seljeseth, Yngve Müller; Ellekjær, Hanne; Pendlebury, Sarah T.; Saltvedt, Ingvild

doi:10.1002/trc2.12000

Cited by 32 publications

(64 citation statements)

References 47 publications

(65 reference statements)

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“…The test battery comprised the Word List Memory and Recall Test and Verbal Fluency Test Category (animals) from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery ( 32 , 33 ); Verbal Fluency Test Letter (FAS) ( 34 , 35 ); Trail Making Tests A (TMT-A) and B (TMT-B) ( 36 ); and the Montreal Cognitive Assessment (MoCA) ( 37 ), version 7.3 at the 3-months follow-up and version 7.1 at the 18-months follow-up. Cognitive function was also assessed with the Global Deterioration Scale (GDS), a global measure of cognitive function originally designed to measure cognitive decline in Alzheimer's disease but shown to be valid also in measuring vascular dementia ( 29 , 38 – 40 ). Activities of daily living (ADL) were assessed with the Barthel Index (BI) ( 41 ) and functional outcome with the Modified Rankin Scale (mRS) ( 42 ).…”

Section: Methodsmentioning

confidence: 99%

“…Data on demographic characteristics and vascular risk factors were collected from medical records. Vascular risk factors were defined as described in previous work in the Nor-COAST study (29) and in the Supplementary Material. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) (30).…”

Section: Clinical Assessmentsmentioning

confidence: 99%

“…Localization of symptoms in the acute phase was collected at admission and categorized as right, left, bilateral, or unable to locate by side. (29,(38)(39)(40). Activities of daily living (ADL) were assessed with the Barthel Index (BI) (41) and functional outcome with the Modified Rankin Scale (mRS) (42).…”

Section: Clinical Assessmentsmentioning

confidence: 99%

“…Z-scores normalized by mean and SD of the normative data were derived from the raw scores of the cognitive tests. The normative data used are presented in previous work (29) as well as in Supplementary Table S1. The symptom profile of PSCI was measured by the z-scores of the five cognitive domains.…”

Section: Statisticsmentioning

confidence: 99%

“…To minimize bias from excluded participants, imputation was performed as described in previous work (29) and as described in the Supplementary Material.…”

Section: Statisticsmentioning

confidence: 99%

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Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

et al. 2020

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Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51-0.66) and 0.51 (0.52-0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language Aam et al. Post-stroke Cognitive Impairment improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Assessmentsmentioning

confidence: 99%

Section: Clinical Assessmentsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

“…To minimize bias from excluded participants, imputation was performed as described in previous work (29) and as described in the Supplementary Material.…”

Section: Statisticsmentioning

confidence: 99%

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