The Prognostic Effects of Poststroke Cognitive Impairment No Dementia and Domain-Specific Cognitive Impairments in Nondisabled Ischemic Stroke Patients

Abstract

Background and Purpose-There is some evidence that poststroke dementia, cognitive impairment no dementia (CIND), and mild cognitive impairment predict for poor outcomes such as dementia, death, and institutionalization. However, few studies have examined the prognostic value of CIND, CIND severity, and domain impairments in a poststroke cohort. Methods-A cohort of ischemic stroke patients with baseline cognitive assessments 3 months poststroke were followed up annually for outcomes of dependency, vascular events, and death for up to 5 years. Univariate and multivariate Cox proportional regression was performed to determine the ability CIND, CIND severity, and domain impairments to predict dependency, vascular outcomes, and death. Results-Four-hundred nineteen patients without dementia (mean age 60Ϯ11 years, 32% female) were followed for a mean of 3.2 years. Older age, diabetes, more severe strokes, CIND-mild, and CIND-moderate were independently predictive of dependency. There were no independent predictors of recurrent vascular events. Older age, diabetes, and CIND-moderate were independently predictive of death. In analyses of individual cognitive domains, impairments in visuomotor speed were independently predictive of dependency. Conclusions-In poststroke patients, CIND predicts dependency and death, while CIND severity discriminates patients with poor survival. Impairments in visuomotor speed independently predict dependency. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT00161070.(Stroke. 2011;42:883-888.)Key Words: dementia Ⅲ stroke Ⅲ mild cognitive impairment Ⅲ cognitive impairment no dementia D ementia, cognitive impairment no dementia (CIND), and mild cognitive impairment (MCI) have become increasingly prevalent in aging populations. CIND is a broad concept that has been used to define impairments in any objective cognitive domain in neuropsychological testing in the absence of dementia. 1 In community-based studies, CIND has been shown to predict for dementia, death, and institutionalization. 2 One study found that poststroke CIND is a negative predictor of survival. 3 Studies have also shown that poststroke dementia (PSD) increases the risk of recurrent vascular events. 4,5 However, no studies to date have examined the effect of CIND on poststroke recurrent vascular events or dependency. We hypothesize that CIND is associated with dependency, recurrent vascular events, and death following ischemic stroke.In a previous study from this cohort, 6 we have shown that CIND severity predicts incident dementia; CIND-mild patients shared a similar risk profile with patients with no cognitive impairment (NCI), and CIND-moderate patients experienced a 6-fold increase in the risk of incident dementia. Because PSD has been associated with recurrent vascular events 4 and death, 7 we hypothesize that a similar association may exist with CIND severity and outcomes after stroke.Previous studies that have examined the prognostic abilities of domain-specific impairments have found tha...

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