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Dement Geriatr Cogn Disord. 2019 Aug 28:1-11. doi: 10.1159/000501850. [Epub ahead of print]

Predictors for Favorable Cognitive Outcome Post-Stroke: A-Seven-Year Follow-Up Study.

Author information

1
Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway, guri.hagberg@gmail.com.
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway, guri.hagberg@gmail.com.
3
Department of Internal Medicine, Karlstad Central Hospital and Institute of Public Health, University of Tromsoe, Tromsoe, Norway.
4
Department of Neurology, Akershus University Hospital, Akershus, Norway.
5
Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway.
6
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
7
Bioinformatics Core Facility, Institute for Cancer Research, Oslo University Hospital and Department of Informatics, University of Oslo, Oslo, Norway.
8
Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
9
Department of Radiology and Nuclear Medicine and Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.
10
Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

BACKGROUND AND PURPOSE:

Knowledge of the burden and development of post-stroke cognitive impairments (CIs) in the long-term after the first event is limited. We aimed to assess the prevalence of mild CI (MCI) and dementia 7 years after first-ever stroke or transient ischemic attack (TIA), to subclassify the impairments, and to identify predictors for a favorable cognitive outcome.

MATERIALS AND METHODS:

During 2007 and 2008, 208 patients with first-ever stroke or TIA without preexisting CI were included. After 1 and 7 years, survivors were invited to a follow-up. Transitions of cognitive status from 1 to 7 years were recorded based on the 3 categories dementia, MCI, or none. Etiologic subclassification was based on clinical cognitive profile, magnetic resonance imaging (MRI) findings, and biomarkers at both time points. Favorable outcome was defined as normal cognitive function or MCI after 7 years with exclusion of those who had progression from normal to MCI.

RESULTS:

Eighty patients died during follow-up, 12 patients refused further participation. After 7 years, 109 completed follow-up of whom 40 (37%) were diagnosed with MCI and 24 (22%) with dementia. Of the 64 patients diagnosed with CI, 9 were subclassified with degenerative cognitive disease, 13 with vascular disease, and 42 had mixed cognitive disease. In all, 65 patients (60%) had a favorable outcome. In multivariable logistic regression analysis, lower age and lower medial temporal lobe atrophy (MTLA) grade on MRI at 12 months were independently associated with a favorable outcome, adjusted OR (95% CI), 0.94 (0.86-0.92), and 0.55 (0.35-0.85), respectively.

CONCLUSIONS:

Sixty percent of stroke survivors have a favorable cognitive outcome. Lower age and lower MTLA grade on MRI were associated with favorable outcome.

KEYWORDS:

Cognitive impairment; Post-stroke dementia; Prognosis; Stroke

PMID:
31461703
DOI:
10.1159/000501850

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