Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death.
Aged
Cause of Death
Cognition
Cognitive Dysfunction
/ diagnosis
Female
Humans
Male
Memory
Memory Disorders
/ diagnosis
Middle Aged
Neuropsychological Tests
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Recurrence
Risk Assessment
Risk Factors
Stroke, Lacunar
/ complications
Time Factors
Cognitive impairment
Cognitive testing
Cohort study
Lacunar stroke
Journal
Cerebrovascular diseases (Basel, Switzerland)
ISSN: 1421-9786
Titre abrégé: Cerebrovasc Dis
Pays: Switzerland
ID NLM: 9100851
Informations de publication
Date de publication:
2021
2021
Historique:
received:
30
09
2020
accepted:
02
01
2021
pubmed:
23
3
2021
medline:
10
8
2021
entrez:
22
3
2021
Statut:
ppublish
Résumé
Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death. After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
Identifiants
pubmed: 33752211
pii: 000514261
doi: 10.1159/000514261
pmc: PMC8266725
mid: NIHMS1668084
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
383-389Subventions
Organisme : NINDS NIH HHS
ID : R01 NS038529
Pays : United States
Informations de copyright
© 2021 S. Karger AG, Basel.
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