Young Ho Park1, Jae-Won Jang2, So Young Park1, Min Jeong Wang1, Jae-Sung Lim3, Min Jae Baek1, Beom Joon Kim1, Moon-Ku Han1, Hee-Joon Bae1, Soyeon Ahn4, SangYun Kim5. 1. Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea. 3. Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. 4. Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea. 5. Clinical Neuroscience Center and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. Electronic address: neuroksy@snu.ac.kr.
Abstract
BACKGROUND: Cognitive impairment impedes stroke rehabilitation. However, it is unclear whether cognitive impairment of specific domains or the degree of severity is more critical to functional recovery in patients with poststroke disability. METHODS: We identified 182 patients who were disabled at 3 months after acute stroke, as defined by a modified Rankin Scale score of 2-5. At a single time point between 3 months and 1 year after onset, the following 4 cognitive domains were assessed: executive function, visuospatial ability, language, and memory. With respect to the severity of cognitive impairment, the patients were classified as having vascular dementia (VD), vascular cognitive impairment no dementia (VCIND), or normal cognition. The primary outcome was functional recovery between 3 months and 1 year after onset. To examine the association between cognitive status and functional recovery, multiple logistic regression with backward stepwise analysis was performed. RESULTS: A total of 74 (40.7% of 182) patients demonstrated functional improvement at 1 year compared with 3 months. Patients with executive impairment demonstrated significantly less improvement in functional outcomes, with an adjusted odds ratio (OR) of .472 (95% confidence interval [CI], .245-.910). Patients with VD also demonstrated less functional recovery, with an adjusted OR of .289 (95% CI, .120-.700). The remaining 3 cognitive domains and VCIND were not significantly associated with functional recovery. CONCLUSIONS: Executive function is a strong predictor of recovery from disability in patients with acute stroke. In addition, functional recovery is significantly hampered by cognitive impairment due to VD, but not VCIND.
BACKGROUND:Cognitive impairment impedes stroke rehabilitation. However, it is unclear whether cognitive impairment of specific domains or the degree of severity is more critical to functional recovery in patients with poststroke disability. METHODS: We identified 182 patients who were disabled at 3 months after acute stroke, as defined by a modified Rankin Scale score of 2-5. At a single time point between 3 months and 1 year after onset, the following 4 cognitive domains were assessed: executive function, visuospatial ability, language, and memory. With respect to the severity of cognitive impairment, the patients were classified as having vascular dementia (VD), vascular cognitive impairment no dementia (VCIND), or normal cognition. The primary outcome was functional recovery between 3 months and 1 year after onset. To examine the association between cognitive status and functional recovery, multiple logistic regression with backward stepwise analysis was performed. RESULTS: A total of 74 (40.7% of 182) patients demonstrated functional improvement at 1 year compared with 3 months. Patients with executive impairment demonstrated significantly less improvement in functional outcomes, with an adjusted odds ratio (OR) of .472 (95% confidence interval [CI], .245-.910). Patients with VD also demonstrated less functional recovery, with an adjusted OR of .289 (95% CI, .120-.700). The remaining 3 cognitive domains and VCIND were not significantly associated with functional recovery. CONCLUSIONS: Executive function is a strong predictor of recovery from disability in patients with acute stroke. In addition, functional recovery is significantly hampered by cognitive impairment due to VD, but not VCIND.
Authors: Tim Vanbellingen; Beatrice Ottiger; Tobias Pflugshaupt; Jan Mehrholz; Stephan Bohlhalter; Tobias Nef; Thomas Nyffeler Journal: Front Neurol Date: 2016-09-26 Impact factor: 4.003
Authors: D Pinter; C Enzinger; T Gattringer; S Eppinger; K Niederkorn; S Horner; S Fandler; M Kneihsl; K Krenn; G Bachmaier; F Fazekas Journal: Eur J Neurol Date: 2019-01-09 Impact factor: 6.089