Relationship between Poststroke Cognition, Baseline Factors, and Functional Outcome: Data from “Efficacy of Nitric Oxide in Stroke” Trial

Ankolekar, Sandeep; Renton, Cheryl; Sare, Gillian; Ellender, Sharon; Sprigg, Nikola; Wardlaw, Joanna M.; Bath, Philip M.W.

doi:10.1016/j.jstrokecerebrovasdis.2014.04.022

Cited by 44 publications

(39 citation statements)

References 41 publications

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“…This is consistent with previous studies that have shown that left hemispheric stroke was an independent predictor of cognitive outcome at 3 months post stroke. 1,29,31,35 The left-sided predominance is not only driven by language deficit but may also be explained by the close relation between language and complex cognitive functions. 29,36 This is supported by our analysis on a subscore in which the most language-dependent items have been removed and which confirmed the improvement of the prediction after adding stroke location as variable.…”

Section: Discussionmentioning

confidence: 99%

Stroke Location Is an Independent Predictor of Cognitive Outcome

Munsch

Sagnier

Asselineau

et al. 2016

Stroke

105

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Background and Purpose-On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Methods-Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. Results-In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Conclusions-Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke.

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Section: Discussionmentioning

confidence: 99%

Stroke Location Is an Independent Predictor of Cognitive Outcome

Munsch

Sagnier

Asselineau

et al. 2016

Stroke

105

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“…Stroke is the second most common cause of acquired cognitive impairment, which predisposes patients toward institutionalization, disability, increased mortality, and poorer quality of life 1, 2, 3. With an aging population and a decline in mortality after stroke,4 the rates of poststroke cognitive impairment will increase.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

126

106

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BackgroundStroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors.Methods and ResultsThree electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow‐up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed.ConclusionsStroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health‐related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.

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“…C ognitive impairment after stroke is associated with depression and worse quality of life, 1 and previous stroke is associated with future risk of dementia. 2,3 Poststroke cognitive decline has been linked to advanced age, premorbid dementia, atrial fibrillation, white matter disease, hippocampal volume, and evidence of lacunar infarcts.…”

mentioning

confidence: 99%

Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

Mandzia

Smith

Horton

et al. 2016

Stroke

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Background and Purpose-Few studies have examined predictors of cognitive impairment after minor ischemic stroke and transient ischemic attack (TIA). We examined clinical and imaging features associated with worse cognitive performance at 90 days. Methods-TIA or patients with minor stroke underwent neuropsychological testing 90 days post event. Z scores were calculated for cognitive tests, and then grouped into domains of executive function (EF), psychomotor processing speed (PS), and memory. White matter hyperintensity and diffusion-weighted imaging volumes were measured on baseline magnetic resonance imaging. Ninety-day outcomes included modified Rankin Scale (mRS) and Centre for Epidemiological Studies Depression Scale (CES-D) score. Results-Ninety-two patients were included, 76% male, 54% TIA, and mean age 65.

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Relationship between Poststroke Cognition, Baseline Factors, and Functional Outcome: Data from “Efficacy of Nitric Oxide in Stroke” Trial

Cited by 44 publications

References 41 publications

Stroke Location Is an Independent Predictor of Cognitive Outcome

Stroke Location Is an Independent Predictor of Cognitive Outcome

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

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