Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda

Abstract

Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda’s Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants’ cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0–28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25–8.33; p = 0.016), functional handicap (mRS 3–5; OR 1.84, 95% CI 1.28–2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14–6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.

Association of socioeconomic status and poststroke cognitive function: A systematic review and meta‐analysis

“…In terms of stroke type, 12 studies exclusively enrolled patients diagnosed with ischemic stroke, 23–34 whereas the remaining included a combination of different stroke types or did not provide information about the stroke type. A total of 17 studies provided data on stroke severity on admission, 13 of which were assessed using the National Institutes of Health Stroke Scale 26,27,29,30,34–42 . Fourteen studies only enrolled participants who experienced their first‐time stroke, 12,28,31,34,36,39,40,42–48 and 16 studies included participants with stroke history 24–27,29,32,33,37,38,41,49–54 .…”

“…A total of 17 studies provided data on stroke severity on admission, 13 of which were assessed using the National Institutes of Health Stroke Scale 26,27,29,30,34–42 . Fourteen studies only enrolled participants who experienced their first‐time stroke, 12,28,31,34,36,39,40,42–48 and 16 studies included participants with stroke history 24–27,29,32,33,37,38,41,49–54 . Two studies did not restrict the stroke history of the participants, but they also provided another set of data specific to first‐time stroke patients 30,34 .…”

“…Fifteen studies tested more than one SES indicator, 12,23–25,28,29,35,38–41,43,46,50,52 while the remaining studies focused solely on a single indicator. Education was examined by most authors ( N = 32).…”

“…divided years of education into 4 levels 27 . Occupation was tested in 16 studies 12,23–25,28,29,35,39–43,45,46,50,52 . Occupational categories such as professionals and skilled workers were considered to have a higher SES, while those who were unemployed, retired, unskilled, or engaged in manual occupations had a lower SES.…”

“…Five studies did not mention the exclusion of prior cognitive impairment or dementia patients at baseline 33,45,52,54,55 . On account of the cognitive outcomes, a total of 19 studies provided data on PSCI as the outcome, 12,27,28,33–40,42,43,45,46,48–50,52 13 reported PSD as the outcome 24–26,29,30,32,41,44,47,51,53–55 . One study reported both PSCI and PSD 31 .…”