Abstract
Background: Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods: We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1-3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke's Cognitive Examination-Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). Results: We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56-74) years, 36/157 (23%) patients had a Addenbrooke's Cognitive Examination-Revised score <82 at one to three months, 29/151 (19%) had a Addenbrooke's Cognitive Examination-Revised <82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). Discussion: This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion: Pre-morbid intelligence should be considered in future studies of post-stroke cognition.
Original language | English |
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Pages (from-to) | 145-156 |
Number of pages | 12 |
Journal | European Stroke Journal |
Volume | 3 |
Issue number | 2 |
Early online date | 8 Jan 2018 |
DOIs | |
Publication status | Published - 1 Jun 2018 |
Bibliographical note
Makin, Stephen Dj Doubal, Fergus N Shuler, Kirsten Chappell, Francesca M Staals, Julie Dennis, Martin S Wardlaw, Joanna M eng MR/K026992/1/Medical Research Council/United Kingdom England Eur Stroke J. 2018 Jun;3(2):145-156. doi: 10.1177/2396987317750517. Epub 2018 Jan 8.Keywords
- National Adult Reading Test
- stroke
- intelligence quotient
- lacunar stroke
- post-stroke dementia
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Stephen Makin
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Lecturer (Clinical)
Person: Clinical Academic