Stability of Estimated Premorbid Cognitive Ability over Time after Minor Stroke and Its Relationship with Post-Stroke Cognitive Ability

Caroline A. McHutchison, Francesca M Chappell, Stephen Makin, Kirsten Shuler, Joanna M Wardlaw (Corresponding Author), Vera Cvoro

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Considering premorbid or "peak" adult intelligence (IQ) is important when examining post-stroke cognition. The stability of estimated premorbid IQ and its relationship to current cognitive ability in stroke is unknown. We investigated changes in estimated premorbid IQ and current cognitive ability up to three years post-stroke. Minor stroke patients (NIHSS <8) were assessed at one to three months, one and three years' post-stroke. The National Adult Reading Test (NART) and Addenbrooke's Cognitive Examination-Revised (ACE-R) were used to estimate premorbid IQ (NART IQ) and current cognitive ability respectively at each time-point. Baseline demographics, vascular and stroke characteristics were included. Of the 264 patients recruited (mean age 66), 158 (60%), 151 (57%), and 153 (58%) completed cognitive testing at each time-point respectively. NART IQ initially increased (mean difference (MD) = 1.32, 95% CI = 0.54 to 2.13, p <0.001) before decreasing (MD = -4.269, 95% CI = -5.12 to -3.41, p <0.001). ACE-R scores initially remained stable (MD = 0.29, 95% CI = -0.49 to 1.07, p > 0.05) before decreasing (MD = -1.05, 95% CI = -2.08 to -0.01, p <0.05). Adjusting for baseline variables did not change the relationship between NART IQ and ACE-R with time. Increases in NART IQ were associated with more education. For ACE-R, older age was associated with declines, and higher NART IQ and more education was associated with increases. Across 3 years, we observed fluctuations in estimated premorbid IQ and minor changes in current cognitive ability. Future research should aim to identify variables associated with these changes. However, studies of post-stroke cognition should account for premorbid IQ.
Original languageEnglish
Article number117
JournalBrain Sciences
Issue number5
Publication statusPublished - 22 May 2019

Bibliographical note

McHutchison, Caroline A Chappell, Francesca M Makin, Stephen Shuler, Kirsten Wardlaw, Joanna M Cvoro, Vera eng Res 14/A157/Chest Heart and Stroke Scotland WT088134/Z/09/A/Wellcome Trust/United Kingdom PHC-03-15, project No 666881, 'SVDs@target'/Horizon 2020 Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease (Ref No: 16 CVD 05)/Fondation Leducq AD.Row4.35/Mrs Gladys Row Fogo Charitable Trust UK MRC DRI UEdin/Medical Research Council/United Kingdom SINAPSE/Scottish Funding Council NHS RS/NHS Research Scotland Switzerland Brain Sci. 2019 May 22;9(5). pii: brainsci9050117. doi: 10.3390/brainsci9050117.


  • Nart
  • cognition
  • premorbid intelligence
  • stroke
  • NART
  • Stroke
  • Premorbid intelligence
  • Cognition
  • IQ
  • LIFE


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