Hyuk Sung Kwon1, Dongwhane Lee2, Min Hwan Lee3, Sungwook Yu4, Jae-Sung Lim5, Kyung-Ho Yu5, Mi Sun Oh5, Ji-Sung Lee6, Keun-Sik Hong7, Eun-Jae Lee3, Dong-Wha Kang3, Sun U Kwon8. 1. Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea. 2. Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea. 3. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. 4. Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea. 5. Department of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Republic of Korea. 6. Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 7. Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea. 8. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. sukwon@amc.seoul.kr.
Abstract
INTRODUCTION: To devise appropriate preventive strategies after stroke, knowledge of the association between post-stroke cognitive impairment (PSCI) and prognosis of stroke patients is important. We investigated the association between PSCI and the vascular outcomes in patients with ischemic stroke with best medical care considering their risk factors and adherence to medications. METHODS: Of the 1534 ischemic stroke patients who randomly assigned to aspirin or cilostazol treatment with best medical therapy by the PICASSO (PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage) trial, 1240 with baseline mini-mental state examination (MMSE) scores were analysed retrospectively. The patients were classified into three groups based on MMSE scores. Recurrence of ischemic stroke, stroke of any type and composite of major vascular events were compared among them. RESULTS: Of the 1240 patients, 376 had MMSE scores of 28-30 (highest tertile), 419 had scores of 24-27 (middle tertile) and 445 had scores of 0-23 (lowest tertile). The average time from stroke onset to MMSE examination was 31.8 days. By trend analysis, lower tertile of MMSE score was significantly associated with recurrent ischemic stroke (p = 0.0017), stroke of any type (p = 0.0053) and composite vascular outcome (p = 0.0122). After adjustment for covariates, PSCI was independently associated with risk of recurrent ischemic stroke (HR 2.40, 95% confidence interval 1.12-5.14). CONCLUSIONS:Cognitive impairment was associated with recurrence of ischemic stroke in high risk patients during adequate medical therapy including antiplatelet therapy. However, the other vascular events were not.
RCT Entities:
INTRODUCTION: To devise appropriate preventive strategies after stroke, knowledge of the association between post-stroke cognitive impairment (PSCI) and prognosis of strokepatients is important. We investigated the association between PSCI and the vascular outcomes in patients with ischemic stroke with best medical care considering their risk factors and adherence to medications. METHODS: Of the 1534 ischemic strokepatients who randomly assigned to aspirin or cilostazol treatment with best medical therapy by the PICASSO (PreventIon of CArdiovascular events in iSchemic Strokepatients with high risk of cerebral hemOrrhage) trial, 1240 with baseline mini-mental state examination (MMSE) scores were analysed retrospectively. The patients were classified into three groups based on MMSE scores. Recurrence of ischemic stroke, stroke of any type and composite of major vascular events were compared among them. RESULTS: Of the 1240 patients, 376 had MMSE scores of 28-30 (highest tertile), 419 had scores of 24-27 (middle tertile) and 445 had scores of 0-23 (lowest tertile). The average time from stroke onset to MMSE examination was 31.8 days. By trend analysis, lower tertile of MMSE score was significantly associated with recurrent ischemic stroke (p = 0.0017), stroke of any type (p = 0.0053) and composite vascular outcome (p = 0.0122). After adjustment for covariates, PSCI was independently associated with risk of recurrent ischemic stroke (HR 2.40, 95% confidence interval 1.12-5.14). CONCLUSIONS:Cognitive impairment was associated with recurrence of ischemic stroke in high risk patients during adequate medical therapy including antiplatelet therapy. However, the other vascular events were not.
Authors: S Melkas; N K J Oksala; H Jokinen; T Pohjasvaara; R Vataja; A Oksala; M Kaste; P J Karhunen; T Erkinjuntti Journal: J Neurol Neurosurg Psychiatry Date: 2009-02-23 Impact factor: 10.154
Authors: Esther M C van Leijsen; Ingeborg W M van Uden; Mohsen Ghafoorian; Mayra I Bergkamp; Valerie Lohner; Eline C M Kooijmans; Helena M van der Holst; Anil M Tuladhar; David G Norris; Ewoud J van Dijk; Loes C A Rutten-Jacobs; Bram Platel; Catharina J M Klijn; Frank-Erik de Leeuw Journal: Neurology Date: 2017-09-06 Impact factor: 9.910