Evolution Of Cognitive Impairment After Stroke And Determination Risk Factors

Objective: Ischemic stroke is a common neurological disease,the prevalence of ischemic stroke is almost 4-fold greater than prevalence of haemorrhagic stroke.Stroke,except for high morbidity,often accompanied with cognitive impairment.The study suggests that 25–30% of ischemic stroke survivors develop immediate or delayed poststroke cognitive impairment(PSCI),which seriously affects the quality of life of patients.There are many studies on the prevalence of PSCI,but the changes of cognitive impairment at different stages are less well-known.The purpose is to evaluate the evolution of cognitive status in acute ischemic stroke during a 3-month follw-up and to identify the factors associated with 3-month post-stroke cognitive impairment(PSCI).Methods:A prospective registry of 251 patients with acute ischemic stroke who were hospitalized continuously from August 2015 to December 2016,who were assessed 3 weeks and 3 months after stroke with an neuropsychological battery,to observe the short-term cognitive function after stroke.Demographics,vascular risk factors,and stroke data were collected,and to explore the influencing factors of PSCI at 3 months after stroke.The diagnosis of PSCI: Patients with cognitive impairment complaints,there was ≥ 1 cognitive domain damage,ADL were affected,and CDR ≥ 0.5,cognitive impairment was related with cerebrovascular disease.The diagnosis of post-stroke cognitive function of the normal: denied any cognitive impairment complaints,ADL was normal,and CDR = 0.1 Short-term cognitive changes after stroke: 251 consecutive patients with acute ischemic stroke,141 patients who met the inclusion criteria and completed the following cognitive function assessment at 3 weeks(at baseline)and 3 months.Cognitive evaluation was performed using the Mini-Mental State Examination(MMSE),the Montreal Cognitive Assessment(MOCA),and Clinical Dementia Rating Scale(CDR).At the same time,cognitive function was divided into CDR = 0,0.5,1,2,3.The short-term change of MMSE,MoCA and CDR were observed.Among the 141 patients who met the inclusion criteria,80 patients completed the executive functional evaluation at follow-up: Clock Drawing Test(CDT),Connection Test A and B(TMT-A and TMT-B),Stroop Color Word Test(SCWT),Verbal Fluency Test(VF),and Digital Span Test(a and b),and to observe the short-term changes of the executive function after stroke.2 The influencing factors of 3-month PSCI: 3 months after stroke,the 141 patients were divided into the following groups: PSCI(59),normal(82),according to the diagnosis of cognitive impairment,combined with CDR.The variables of P <0.1 in the univariate analysis were included in the regression equation,and the independent risk factors of PSCI were identfied by multivariate logistic regression analysis.Results: Of the 251 subjects,25 patients whose benefit side hand muscle strength 3 below can not complete the evaluation,17 cases of severe aphasia,dysphonia,23 cases of disturbance of consciousness,10 cases of severe depression in prestroke or poststroke,death or refusion to comment on 35 cases were excluded,and finally 141 cases were included.141 patients completed MMSE,MoCA,and CDR at baseline and at 3 months,and 80 patients completed the executive function assessment.Aged 36 to 87 years,mean age(58.738 ± 11.279)years old,103 males and 38 females.Education level: illiterate 15(10.6%)cases,primary school 48(34.0%)cases,junior high school and above 46(32.6%)cases,college and above 33(23.4%)cases.1 The prevalencce of cognitive function after strokeOf the 141 subjects,52.5% was classified as cognitive impairment at baseline,compared to 41.8% at follow-up,whereas that of dementia were 24.1% and 16.3%,respectively.2 Evolution of cognitive impairment after stroke2.1 The change of CDR at baseline and 3-month after strokeCognitive status at 3 months was stable in most cases(102;72.3%),improved in 34 patients: 18 CDR 0.5 to 0,11 CDR 1 to 0.5,3 CDR 2 to 1 or 0.5,and 2 CDR 3 to 2,and decline progressed in 5 patients: 1 CDR 0 to 0.5,and 4 CDR 0.5 to 1.2.2 The change of MMSE and MoCA at baseline and 3-month after stroke141 patients completed MMSE and MoCA.MMSE and MoCA scores were compared at baseline and 3 months after stroke.Although both MMSE and MoCA had a lower score,the scores were higher at 3 months after stroke than at baseline.2.3 The change of executive function at baseline and 3-month after strokeIn 80 patients,executive function were compared at the baseline and 3 months,the patients had poor executive function scores at baseline and 3 months,but scores were higher at baseline than baseline at 3 months after stroke,mainly in the following: CDT,TMT-B,digital breadth(b)tests,SCWT-b(time consuming),SCWT-c(correct number),SCWT-c(time consuming),SIE(correct number),SIE(time consuming)(P <0.05)..3 Risk factor analysis of PSCIIn multivariable analyses,3-month PSCI was associated with age(OR=1.187;95%CI: 1.044-1.350;P <0.05),number of silent infarcts(≥5)(OR=106.602;95%CI: 3.746-3030.361;P <0.05),and progressed stroke(OR=0.097;95%CI: 0.010-0.969;P < 0.05).The Montreal Cognitive Assessment(MoCA)scores during baseline was associated with 3-month PSCI(OR=0.587;95%CI: 0.446-0.771;P <0.001).Conclusion:1 The study underlines the high frequency of PSCI2 Cognition is rather stable for 3 months after acute ischemic stroke.Both progression and improvement of cognitive function are frequent in PSCI patients.3 Age,silent infarcts(≥5),progressed stroke,and MoCA scores during baseline are risk factors for 3-month PSCI.