Progression of cognitive impairment after stroke

Tham, Wendy W.P.; Auchus, Alexander P.; Thong, Melissa S. Y.; Goh, M.Z.H.; Chang, Hui-Meng; Wong, Michael; Chen, Christopher P.L.-H.

doi:10.1016/s0022-510x(02)00260-5

Cited by 129 publications

(36 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1), 159 articles were analyzed and 16 studies were selected, corresponding to a total of 3,087 patients. Ineligible studies on post-stroke NCD included cross-sectional studies resulting in variable post-stroke intervals [10], non-consecutive patients [11-16], studies which failed to report the rates of both mild and major post-stroke NCD, and studies that did not use a neuropsychological battery [12-14, 17-44]. …”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies

Barbay¹,

Diouf²,

Roussel³

et al. 2018

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background/Aims: Post-stroke neurocognitive disorders (post-stroke NCD) have been reported with a very variable prevalence. Methods: Based on a systematic literature search, hospital-based studies published between January 1990 and September 2015 were selected when they reported the prevalence of total, mild, and major post-stroke NCD diagnosed by using specified criteria. Factors affecting prevalence were assessed using meta-regression analysis. Results: Among the 7,440 references evaluated, 16 hospital-based studies were selected, corresponding to a total of 3,087 patients. The overall prevalence of total post-stroke NCD was 53.4% (95% CI: 46.9–59.8): 36.4% for mild post-stroke NCD (95% CI: 29–43.8) and 16.5% (95% CI: 12.1–20.8) for major post-stroke NCD. The overall prevalence was mainly influenced by the threshold score used for categorization (p = 0.0001) and, in the subgroup of studies using a conservative threshold (i.e., ≤7th percentile), by the recurrent stroke rate (p = 0.0005). The prevalence of major post-stroke NCD was mainly influenced by age (p = 0.003). Conclusion: More than half of stroke survivors experience post-stroke NCD, corresponding to mild post-stroke NCD in two-thirds of cases and major post-stroke NCD in one-third of cases. Harmonization of stroke assessment and cognitive score thresholds is urgently needed to allow more accurate estimation of post-stroke NCD prevalence, especially mild post-stroke NCD.

show abstract

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies

Barbay¹,

Diouf²,

Roussel³

et al. 2018

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

show abstract

“…Use of different tests and cutoff points may explain reported variations in prevalence and severity of cognitive impairment. For instance, Tham et al [3] reported that 40% of 252 patients had cognitive impairment but no dementia and 4% had VaD 6 months poststroke, while Rasquin et al [5] in 176 patients with first-ever brain infarct found only 25.6% with no cognitive impairment 6 months after stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Ischemic stroke is a significant risk factor for vascular cognitive impairment and vascular dementia (VaD) [2]. Six months after stroke, as many as 44–74% of patients present some degree of cognitive disturbance [3,4,5]. Stroke patients with cognitive impairment but no dementia increase the 5-year risk of developing VaD and other dementias [6].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Treatment with Citicoline May Improve Poststroke Vascular Cognitive Impairment

et al. 2013

View full text Add to dashboard Cite

Background: Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment after stroke. We assessed the safety of long-term administration and its possible efficacy of citicoline in preventing poststroke cognitive decline in patients with first-ever ischemic stroke. Methods: Open-label, randomized, parallel study of citicoline vs. usual treatment. All subjects were selected 6 weeks after suffering a qualifying stroke and randomized by age, gender, education and stroke type into parallel arms of citicoline (1 g/day) for 12 months vs. no citicoline (control group). Medical management was similar otherwise. All patients underwent neuropsychological evaluation at 1 month, 6 months and 1 year after stroke. Tests results were combined to give indexes of 6 neurocognitive domains: attention and executive function, memory, language, spatial perception, motor speed and temporal orientation. Using adjusted logistic regression models we determined the association between citicoline treatment and cognitive decline for each neurocognitive domain at 6 and 12 months. Results: We recruited 347 subjects (mean age 67.2 years, 186 male (56.6%), mean education 5.7 years); 172 (49.6%) received citicoline for 12 months (no significant differences from controls n = 175). Demographic data, risk factors, initial stroke severity (NIHSS), clinical and etiological classification were similar in both groups. Only 37 subjects (10.7%) discontinued treatment (10.5% citicoline vs. 10.9% control) at 6 months; 30 (8.6%) due to death (16 (9.3%) citicoline vs. 14 (8.0%) control, p = 0.740), 7 lost to follow-up or incorrect treatment, and 4 (2.3%) had adverse events from citicoline without discontinuation. 199 patients underwent neuropsychological evaluation at 1 year. Cognitive functions improved 6 and 12 months after stroke in the entire group but in comparison with controls, citicoline-treated patients showed better outcome in attention-executive functions (OR 1.721, 95% CI 1.065–2.781, p = 0.027 at 6 months; OR 2.379, 95% CI 1.269–4.462, p = 0.007 at 12 months) and temporal orientation (OR 1.780, 95% CI 1.020–3.104, p = 0.042 at 6 months; OR 2.155, 95% CI 1.017–4.566, p = 0.045 at 12 months) during the follow-up. Moreover, citicoline group showed a better functional outcome (modified Rankin scale ≤2) at 12 months (57.3 vs. 48.7%) without statistically significant differences (p = 0.186). Conclusions: Citicoline treatment for 12 months in patients with first-ever ischemic stroke is safe and probably effective in improving poststroke cognitive decline. Citicoline appears to be a promising agent to improve recovery after stroke. Large clinical trials are needed to confirm the net benefit of this therapeutic approach.

show abstract

“…In contrast, a cohort study of younger stoke patients (mean age, 60 years) showed that more than 30% of the patients with mild cognitive impairments between 0 and 6 months were classified as cognitively intact by 12 to 18 months [16]. For older patients (mean age, 80.4 ± 3.8), about 50% of the patients experienced an improvement in MMSE at 15 months [17].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with improvement or decline in cognitive function after an ischemic stroke in Korea: the Korean stroke cohort for functioning and rehabilitation (KOSCO) study

et al. 2017

View full text Add to dashboard Cite

BackgroundWe conducted a prospective cohort study to investigate prevalence of poststroke cognitive impairment at 3 and 12 months after stroke onset and identify clinical and demographic factors associated with improvement or decline in cognitive function between 3 months and 12 months.MethodsWe analyzed the cognitive assessments of total patients and patients older than 65 years separately. All patients with an ischemic stroke were divided into normal cognitive group (NCG) and impaired cognition group (ICG) by using a cutoff score on the Korean Mini-Mental State Examination (K-MMSE). Patients were additionally classified into 3 subgroups according to the changes in their K-MMSE scores between 3 and 12 months: Stable group with K-MMSE scores changes ranging from −2 to +2 points (−2 ≤ △MMSE ≤ +2); converter group with increase more than 3 points (3 ≤ △MMSE); and reverter group with decrease more than 3 points (−3 ≤ △MMSE). We also analyzed factors affecting cognitive change from 3 months to 12 months among the 3 groups including baseline medical record, stroke and treatment characteristics, and various functional assessments after 3 months.ResultsThis study included 2,625 patients with the first time ischemic stroke. Among these patients, 1,735 (66.1%) were classified as NCG, while 890 patients (33.9%) were belonged to the ICG at 3 month. Within the NCG, 1,460 patients (82.4%) were stable group, 93 patients (5.4%) were converter group, and 212 patients (12.2%) were reverter group at 12 months onset. Within the ICG group, 472 patients (53.0%) were stable group, 321 patients (36.1%) were converter group, and 97 patients (10.9%) were reverter group. When different factors were investigated, the three subgroups in NCG and ICG showed significant different factors affecting cognitive function from 3 to 12 month.ConclusionsThe prevalence of cognitive impairment showed difference between 3,12 months. To analyze the cognitive change from 3 month to 12 month, the proportion stable group was dominant in NCG and converter group was higher in ICG. By investigating the influencing factors from each group, we were able to identify the predictors including the age factor.

show abstract

Progression of cognitive impairment after stroke

Cited by 129 publications

References 10 publications

Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies

Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies

Long-Term Treatment with Citicoline May Improve Poststroke Vascular Cognitive Impairment

Factors associated with improvement or decline in cognitive function after an ischemic stroke in Korea: the Korean stroke cohort for functioning and rehabilitation (KOSCO) study

Contact Info

Product

Resources

About