The Association between Psychiatric and Cognitive Symptoms after Stroke: A Prospective Study

Abstract

Background: Stroke patients often have neuropsychiatric symptoms and cognitive deficits. The aim of this study was to investigate whether stroke patients with psychiatric symptoms are at increased risk of developing cognitive deficits. Methods: Cognitive function (assessed with a neuropsychological test battery) and presence of psychiatric symptoms (assessed with the 90-item Symptom Checklist) were evaluated at 1, 6, 12 and 24 months after stroke. Results: At baseline, 156 patients entered the study, 15 had a diagnosis of vascular dementia, 113 one of post-stroke mild cognitive impairment. Patients with psychiatric symptoms were found to be at increased risk of being diagnosed as having vascular dementia at baseline (OR = 6.9, CI = 1.3–36.8) and showed more decline on cognitive function 6 months after stroke. Conclusions: Patients with psychiatric symptoms after stroke are at increased risk of cognitive deficits and decline in cognitive functioning.

Frequency and Prognostic Value of Cognitive Disorders in Stroke Patients

“…This difference was larger than that reported in previous studies [3,5,22] . This result is of particular importance since the presence of executive dysfunction in the second week after stroke emerged as the only predictor of functional recovery after 1 year.…”

“…This critical role of executive dysfunction (which refers to higher-order programming and the cognitive control of goal-directed behavior [29,30] ) in predicting the functional outcome is of great relevance for routine cognitive assessment of stroke patients. The most widely used cognitive screening test, the Mini-Mental State Examination, is not sensitive to frontal executive functions [18,22,31] . It is, therefore, necessary to include additional measures of frontal-executive functions in future screenings for vascular patients.…”

Cognitive function following stroke and vascular cognitive impairment

“…Stroke patients with early depressive symptoms are at increased risk for cognitive impairment [33 ] and 'vascular dementia' (at baseline and after 6 months) [34]. The inverse relation has been shown as well, that is early cognitive impairment predicts the presence of depressive symptoms six months later [11].…”

‘Alzheimer's disease’: more data, but are we any more informed?

“…Rasquin, Verhey and other colleagues [49][50][51][52][53] tried to resolve the rather more complex underlying mechanisms in a series of papers. They found that the positive predictive accuracy of 'amnestic MCI' and 'multiple domain MCI' was poor for all types of dementia [49]; 10% of the patients had dementia after stroke, but twothirds had MCI after stroke [53]; additional psychiatric symptoms after stroke were associated with a diagnosis of dementia and poor cognitive prognosis [50]; higher age, territorial infarction and low educational level were predictors of sustained or increasing cognitive deficits after stroke [51]; 20% of the patients with MCI after stroke recovered cognitively, most of them within the first 6 months, and primarily those with better cognitive performance and female gender [53].…”