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

Abstract

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.

Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study

“…In addition, EQ-5D VAS has been found to have poor reliability among participants with cognitive impairment [50], and the frail group had a lower MoCA score compared to both the robust and prefrail groups (19.4p vs. 25.4p and 23.2p, respectively), indicating a higher degree of cognitive impairment. Also, post-stroke cognitive impairment was found to be common among the participants in the Nor-COAST study in an additional study by Aam et al [51]. Finally, frail people tend to better adapt to disability by means of the 'response shift phenomena' [52,53], meaning that while an increased disability will affect a frail person's EQ-5D-5L index negatively, it may not play any role in the subjective impression of their overall health.…”

Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee

“…Finally, it should be mentioned that predictors of minor and major CI after ischemic stroke and after intracerebral haemorrhage appear to be largely similar, 22 with haemorrhagic stroke associated with an increased risk of PSCI compared with ischemic stroke. 48,55…”

“…44 While early PSCI showed the strongest association with infarct features (mostly size and location), delayed PSCI was strongly associated with (pre-existing) SVD on MRI, 45 although these findings await replication in other studies. PSCI risk may differ according to stroke subtype, with an increased risk of CI for cardioembolic etiology and large artery atherosclerosis, 46,47 while others reported no differences after adjustment for other factors such as stroke severity and premorbid status, 48 or noted a significant progressive trend of CI among patients with small vessel disease and lacunes up to 5 years after stroke 47 (Table 1).…”

“…Finally, it should be mentioned that predictors of minor and major CI after ischemic stroke and after intracerebral haemorrhage appear to be largely similar, 22 with haemorrhagic stroke associated with an increased risk of PSCI compared with ischemic stroke. 48,55 Clinical predictors. Predictors are of particular interest in the context of PSCI, to identify patients at high-risk for CI promptly identified after the acute event.…”

Are Sarcopenia and Cognitive Dysfunction Comorbid after Stroke in the Context of Brain–Muscle Crosstalk?

“…A Norwegian longitudinal study of 617 patients with stroke (mean age 72 ± 12, 42% women) investigated the effect of stroke severity on cognitive dysfunction [ 19 ]. The assessed domains of cognitive function included attention, executive function, memory, language, and perceptual-motor function.…”