Einor Ben Assayag1, Shani Shenhar-Tsarfaty1, Amos D Korczyn1, Efrat Kliper1, Hen Hallevi1, Ludmila Shopin1, Eitan Auriel1, Nir Giladi1, Anat Mike1, Anat Halevy1, Aner Weiss1, Anat Mirelman1, Natan M Bornstein2, Jeffrey M Hausdorff1. 1. From the Stroke Unit and the Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel (E.B.A., S.-S.T., E.K., H.H., L.S., E.A., N.G., A. Mike, A.H., A.W., A. Mirelman, N.M.B.); and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.B.A., A.D.K., E.K., H.H., E.A., N.G., N.M.B., J.M.H.). 2. From the Stroke Unit and the Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel (E.B.A., S.-S.T., E.K., H.H., L.S., E.A., N.G., A. Mike, A.H., A.W., A. Mirelman, N.M.B.); and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (E.B.A., A.D.K., E.K., H.H., E.A., N.G., N.M.B., J.M.H.). strokeun@tlvmc.gov.il.
Abstract
BACKGROUND AND PURPOSE: Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors. METHODS: Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event. RESULTS: Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (P<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (P<0.001), slower gait (P<0.001), and fewer correct answers during dual-task walking (P=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36-27.15). CONCLUSIONS: These results suggest that measures of balance and gait are significant risk markers of cognitive status 2 years after stroke. Relatively simple, performance-based tests of mobility may enhance the identification of stroke/transient ischemic attack survivors who have an increased risk of developing CD. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
BACKGROUND AND PURPOSE:Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors. METHODS:Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event. RESULTS: Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (P<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (P<0.001), slower gait (P<0.001), and fewer correct answers during dual-task walking (P=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36-27.15). CONCLUSIONS: These results suggest that measures of balance and gait are significant risk markers of cognitive status 2 years after stroke. Relatively simple, performance-based tests of mobility may enhance the identification of stroke/transient ischemic attack survivors who have an increased risk of developing CD. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
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