Prior studies have identified numerous factors associated with long-term cognitive impairment in stroke patients including: white matter disease ( 7), lower educational level, older age, female sex, recurrent stroke, and global cortical atrophy in patients with ischemic stroke and vascular cognitive impairment ( 8). Our study takes the logical next step and addresses the ability of in-hospital variables to predict cognitive impairment and functional status once patients have been discharged home from the inpatient setting and are transitioning back to a “normal life.” These early months represent a critical time when patients and families make decisions regarding returning to work, living alone, and functioning independently. Cognitive dysfunction in stroke patients can result in deficits such as impaired activities of daily living (ADLs) and instrumental activities of daily living (IADLs), lost wages, increased health care costs, loss of independence, and social isolation.Ī recent retrospective study showed an association between MoCA scores documented acutely after stroke and functional outcome during rehabilitation ( 6). Impairment has been reported to affect multiple cognitive domains ( 5), though a recent study evaluating those with transient ischemic attack and minor stroke found difficulty with executive function and psychomotor processing to be the most common cognitive deficits ( 6). One follow-up study reported that over a quarter of stroke patients display delayed dementia, while additional studies using more formalized neuropsychological assessments such as the Montreal Cognitive Assessment (MoCA) or Mini-Mental Status Examination have reported rates of cognitive impairment ranging from 35 to 92% ( 2– 4). The prevalence of dementia in patients with a history of ischemic stroke is nearly thirty percent 3.5–5.8 times higher than in patients without a stroke history ( 1). There is a known link between ischemic stroke and long-term cognitive impairment. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) 6, and left-sided infarct predicted a follow-up MoCA 6 and infarct volume > 17 cc predicted a MoCA < 19 (c-statistic 0.75) at follow-up.Ĭonclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction. 2Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, United States.1Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
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