Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

C. A. McHutchison; V. Cvoro; S. Makin; F. M. Chappell; K. Shuler; J. M. Wardlaw

doi:10.1136/jnnp-2018-319134

Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

C. A. McHutchison, V. Cvoro, S. Makin, F. M. Chappell, K. Shuler, J. M. Wardlaw (Corresponding Author)

Applied Health Sciences

University of Edinburgh

Research output: Contribution to journal › Article › peer-review

33 Citations (Scopus)

7 Downloads (Pure)

Abstract

Objective Many studies examining stroke outcomes focus on more severe strokes or have short follow-up periods, so the long-term outcomes post-minor ischaemic stroke are unclear. Methods We recruited participants from inpatient and outpatient services with a lacunar or minor cortical ischaemic stroke (National Institutes of Health Stroke Scale score <8) and assessed current and premorbid cognitive functioning (Addenbrooke’s Cognitive Examination–Revised (ACE-R), National Adult Reading Test (NART)), physical functioning (Timed Get Up and Go (TUG), 9-Hole Peg Test (9HPT)), dependency (modified Rankin Scale (mRS)), depression (Beck’s Depression Inventory) in-person and remotely (Stroke Impact Scale). Results We followed up 224/264 participants at 3 years (mean age at index stroke=67, 126 (56%) men, 25 non-contactable, 15 declined): 66/151 (44%) had cognitive impairment, mean ACE-R 88 (SD 9, range 54–100/100), 61/156 (39%) had depression and 26/223 (12%) were dependent (mRS=3–5). Cognitive impairment at 3 years affected all ACE-R subdomains and was associated with ACE-R 1 year (β=1.054, p<0.001) and NART (β=1.023, p<0.05). Poor physical function was associated with stroke severity (TUG, β=1.064, p<0.01) and recurrent stroke (9HPT, β=1.130, p<0.05 right, β=1.214, p<0.05 left). Higher ACE-R scores were associated with faster TUG (β=−0.279, p<0.05) and 9HPT (right β=−0.257, p<0.05; left β=−0.302, p=0.05) and inversely with dependency (mRS=3–5, OR 0.88, 95% CI 0.80 to 0.97). We adjusted analyses for demographic, stroke and known risk factors. In-person and remote assessments were highly correlated. Conclusions Cognitive, physical impairments and depression are common and interrelated 3 years after minor stroke. Cognitive and physical impairments require rehabilitation after minor stroke and argue for better integration of stroke and dementia services.

Original language	English
Pages (from-to)	436-443
Number of pages	8
Journal	Journal of Neurology, Neurosurgery & Psychiatry
Volume	90
Issue number	4
Early online date	15 Dec 2018
DOIs	https://doi.org/10.1136/jnnp-2018-319134
Publication status	Published - 2019

Bibliographical note

Chest, Heart Stroke Scotland, Ref No: Res14/A157; NHS Research
Scotland; The Wellcome Trust (WT088134/Z/09/A); the Row Fogo Charitable Trust;
the European Union Horizon 2020, PHC-03-15, project No 666881, ’SVDs@
target’; the Fondation Leducq Transatlantic Network of Excellence for the Study
of Perivascular Spaces in Small Vessel Disease, Ref No: 16 CVD 05; the Medical
Research Council through the UK Dementia Research Institute; the Scottish Funding
Council through the Scottish Imaging Network, A

Keywords

activities of daily living cognition dependency stroke walking speed Heart, Stroke Scotland, which funded the study. JMW reports grants from Chest, Heart, Stroke Scotland, grants from the Sackler Foundation, European Union Horizon 2020 grant No 666881, 'SVDs@target', Fondation Leducq, UK Medical Research Council, Stroke Association, Alzheimer's Society and British Heart Foundation.
Stroke
Activities of daily living
Cognition
Dependency
Walking speed
BATTERY
DISORDERS
RISK
IMPAIRMENT
INTELLIGENCE
IMPACT
MOTOR RECOVERY
ACE-R
SCALE
MENTAL-STATE

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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https://www.ncbi.nlm.nih.gov/pubmed/30554134

Cite this

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title = "Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke",

abstract = "Objective Many studies examining stroke outcomes focus on more severe strokes or have short follow-up periods, so the long-term outcomes post-minor ischaemic stroke are unclear. Methods We recruited participants from inpatient and outpatient services with a lacunar or minor cortical ischaemic stroke (National Institutes of Health Stroke Scale score <8) and assessed current and premorbid cognitive functioning (Addenbrooke{\textquoteright}s Cognitive Examination–Revised (ACE-R), National Adult Reading Test (NART)), physical functioning (Timed Get Up and Go (TUG), 9-Hole Peg Test (9HPT)), dependency (modified Rankin Scale (mRS)), depression (Beck{\textquoteright}s Depression Inventory) in-person and remotely (Stroke Impact Scale). Results We followed up 224/264 participants at 3 years (mean age at index stroke=67, 126 (56%) men, 25 non-contactable, 15 declined): 66/151 (44%) had cognitive impairment, mean ACE-R 88 (SD 9, range 54–100/100), 61/156 (39%) had depression and 26/223 (12%) were dependent (mRS=3–5). Cognitive impairment at 3 years affected all ACE-R subdomains and was associated with ACE-R 1 year (β=1.054, p<0.001) and NART (β=1.023, p<0.05). Poor physical function was associated with stroke severity (TUG, β=1.064, p<0.01) and recurrent stroke (9HPT, β=1.130, p<0.05 right, β=1.214, p<0.05 left). Higher ACE-R scores were associated with faster TUG (β=−0.279, p<0.05) and 9HPT (right β=−0.257, p<0.05; left β=−0.302, p=0.05) and inversely with dependency (mRS=3–5, OR 0.88, 95% CI 0.80 to 0.97). We adjusted analyses for demographic, stroke and known risk factors. In-person and remote assessments were highly correlated. Conclusions Cognitive, physical impairments and depression are common and interrelated 3 years after minor stroke. Cognitive and physical impairments require rehabilitation after minor stroke and argue for better integration of stroke and dementia services.",

keywords = "activities of daily living cognition dependency stroke walking speed Heart, Stroke Scotland, which funded the study. JMW reports grants from Chest, Heart, Stroke Scotland, grants from the Sackler Foundation, European Union Horizon 2020 grant No 666881, 'SVDs@target', Fondation Leducq, UK Medical Research Council, Stroke Association, Alzheimer's Society and British Heart Foundation., Stroke, Activities of daily living, Cognition, Dependency, Walking speed, BATTERY, DISORDERS, RISK, IMPAIRMENT, INTELLIGENCE, IMPACT, MOTOR RECOVERY, ACE-R, SCALE, MENTAL-STATE",

author = "McHutchison, {C. A.} and V. Cvoro and S. Makin and Chappell, {F. M.} and K. Shuler and Wardlaw, {J. M.}",

note = "Chest, Heart Stroke Scotland, Ref No: Res14/A157; NHS Research Scotland; The Wellcome Trust (WT088134/Z/09/A); the Row Fogo Charitable Trust; the European Union Horizon 2020, PHC-03-15, project No 666881, {\textquoteright}SVDs@ target{\textquoteright}; the Fondation Leducq Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease, Ref No: 16 CVD 05; the Medical Research Council through the UK Dementia Research Institute; the Scottish Funding Council through the Scottish Imaging Network, A",

year = "2019",

doi = "10.1136/jnnp-2018-319134",

language = "English",

volume = "90",

pages = "436--443",

journal = "Journal of Neurology, Neurosurgery & Psychiatry",

issn = "1468-330X",

publisher = "BMJ Publishing Group",

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}

TY - JOUR

T1 - Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

AU - McHutchison, C. A.

AU - Cvoro, V.

AU - Makin, S.

AU - Chappell, F. M.

AU - Shuler, K.

AU - Wardlaw, J. M.

N1 - Chest, Heart Stroke Scotland, Ref No: Res14/A157; NHS Research Scotland; The Wellcome Trust (WT088134/Z/09/A); the Row Fogo Charitable Trust; the European Union Horizon 2020, PHC-03-15, project No 666881, ’SVDs@ target’; the Fondation Leducq Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease, Ref No: 16 CVD 05; the Medical Research Council through the UK Dementia Research Institute; the Scottish Funding Council through the Scottish Imaging Network, A

PY - 2019

Y1 - 2019

N2 - Objective Many studies examining stroke outcomes focus on more severe strokes or have short follow-up periods, so the long-term outcomes post-minor ischaemic stroke are unclear. Methods We recruited participants from inpatient and outpatient services with a lacunar or minor cortical ischaemic stroke (National Institutes of Health Stroke Scale score <8) and assessed current and premorbid cognitive functioning (Addenbrooke’s Cognitive Examination–Revised (ACE-R), National Adult Reading Test (NART)), physical functioning (Timed Get Up and Go (TUG), 9-Hole Peg Test (9HPT)), dependency (modified Rankin Scale (mRS)), depression (Beck’s Depression Inventory) in-person and remotely (Stroke Impact Scale). Results We followed up 224/264 participants at 3 years (mean age at index stroke=67, 126 (56%) men, 25 non-contactable, 15 declined): 66/151 (44%) had cognitive impairment, mean ACE-R 88 (SD 9, range 54–100/100), 61/156 (39%) had depression and 26/223 (12%) were dependent (mRS=3–5). Cognitive impairment at 3 years affected all ACE-R subdomains and was associated with ACE-R 1 year (β=1.054, p<0.001) and NART (β=1.023, p<0.05). Poor physical function was associated with stroke severity (TUG, β=1.064, p<0.01) and recurrent stroke (9HPT, β=1.130, p<0.05 right, β=1.214, p<0.05 left). Higher ACE-R scores were associated with faster TUG (β=−0.279, p<0.05) and 9HPT (right β=−0.257, p<0.05; left β=−0.302, p=0.05) and inversely with dependency (mRS=3–5, OR 0.88, 95% CI 0.80 to 0.97). We adjusted analyses for demographic, stroke and known risk factors. In-person and remote assessments were highly correlated. Conclusions Cognitive, physical impairments and depression are common and interrelated 3 years after minor stroke. Cognitive and physical impairments require rehabilitation after minor stroke and argue for better integration of stroke and dementia services.

AB - Objective Many studies examining stroke outcomes focus on more severe strokes or have short follow-up periods, so the long-term outcomes post-minor ischaemic stroke are unclear. Methods We recruited participants from inpatient and outpatient services with a lacunar or minor cortical ischaemic stroke (National Institutes of Health Stroke Scale score <8) and assessed current and premorbid cognitive functioning (Addenbrooke’s Cognitive Examination–Revised (ACE-R), National Adult Reading Test (NART)), physical functioning (Timed Get Up and Go (TUG), 9-Hole Peg Test (9HPT)), dependency (modified Rankin Scale (mRS)), depression (Beck’s Depression Inventory) in-person and remotely (Stroke Impact Scale). Results We followed up 224/264 participants at 3 years (mean age at index stroke=67, 126 (56%) men, 25 non-contactable, 15 declined): 66/151 (44%) had cognitive impairment, mean ACE-R 88 (SD 9, range 54–100/100), 61/156 (39%) had depression and 26/223 (12%) were dependent (mRS=3–5). Cognitive impairment at 3 years affected all ACE-R subdomains and was associated with ACE-R 1 year (β=1.054, p<0.001) and NART (β=1.023, p<0.05). Poor physical function was associated with stroke severity (TUG, β=1.064, p<0.01) and recurrent stroke (9HPT, β=1.130, p<0.05 right, β=1.214, p<0.05 left). Higher ACE-R scores were associated with faster TUG (β=−0.279, p<0.05) and 9HPT (right β=−0.257, p<0.05; left β=−0.302, p=0.05) and inversely with dependency (mRS=3–5, OR 0.88, 95% CI 0.80 to 0.97). We adjusted analyses for demographic, stroke and known risk factors. In-person and remote assessments were highly correlated. Conclusions Cognitive, physical impairments and depression are common and interrelated 3 years after minor stroke. Cognitive and physical impairments require rehabilitation after minor stroke and argue for better integration of stroke and dementia services.

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KW - Activities of daily living

KW - Cognition

KW - Dependency

KW - Walking speed

KW - BATTERY

KW - DISORDERS

KW - RISK

KW - IMPAIRMENT

KW - INTELLIGENCE

KW - IMPACT

KW - MOTOR RECOVERY

KW - ACE-R

KW - SCALE

KW - MENTAL-STATE

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Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

Abstract

Bibliographical note

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UN SDGs

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Stephen Makin

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Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

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Stephen Makin

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