The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study

Abstract

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

Association between diabetes mellitus and post‐stroke cognitive impairment

“…One interesting study demonstrated that language improvement was noted particularly in patients with diabetes mellitus, as well as in patients with hypercholesterolemia and coronary artery disease. 32 For late PSCI, patients with stroke and type 2 diabetes mellitus have worse cognitive function after 2 years. 17 , 33 , 34 During the chronic phase, diabetes mellitus may even outweigh the effects of severe mesial temporal atrophy.…”

Plasma Inflammatory Biomarkers Are Associated With Poststroke Cognitive Impairment: The Nor-COAST Study

“…Complementary information regarding definitions; the cognitive test battery 2 , 19 , 29 ; plasma samples; and statistics are described in the Supplemental Material .…”

Multimodal individualised intervention to prevent functional decline after stroke: protocol of a randomised controlled trial on long-term follow-up after stroke (LAST-long)

“…All participants in LAST-long undergo evidence-based comprehensive stroke unit treatment in the acute phase and further rehabilitation according to individual needs after discharge from hospital. 12 The rehabilitation usually consists of inpatient rehabilitation, rehabilitation in the patient’s home or at an outpatient clinic and is often limited to the first 3 months for patients with mild-to-moderate strokes but can last for up to 6 months for patients with the most severe strokes and for selected patients even longer. According to the National guidelines, patients are offered a follow-up consultation at the stroke units’ outpatient clinic 3 months after stroke.…”