Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke

C. A. McHutchison, V. Cvoro, S. Makin, F. M. Chappell, K. Shuler, J. M. Wardlaw (Corresponding Author)

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Abstract

Objective Many studies examining stroke outcomes focus on more severe strokes or have short follow-up periods, so the long-term outcomes post-minor ischaemic stroke are unclear. Methods We recruited participants from inpatient and outpatient services with a lacunar or minor cortical ischaemic stroke (National Institutes of Health Stroke Scale score <8) and assessed current and premorbid cognitive functioning (Addenbrooke’s Cognitive Examination–Revised (ACE-R), National Adult Reading Test (NART)), physical functioning (Timed Get Up and Go (TUG), 9-Hole Peg Test (9HPT)), dependency (modified Rankin Scale (mRS)), depression (Beck’s Depression Inventory) in-person and remotely (Stroke Impact Scale). Results We followed up 224/264 participants at 3 years (mean age at index stroke=67, 126 (56%) men, 25 non-contactable, 15 declined): 66/151 (44%) had cognitive impairment, mean ACE-R 88 (SD 9, range 54–100/100), 61/156 (39%) had depression and 26/223 (12%) were dependent (mRS=3–5). Cognitive impairment at 3 years affected all ACE-R subdomains and was associated with ACE-R 1 year (β=1.054, p<0.001) and NART (β=1.023, p<0.05). Poor physical function was associated with stroke severity (TUG, β=1.064, p<0.01) and recurrent stroke (9HPT, β=1.130, p<0.05 right, β=1.214, p<0.05 left). Higher ACE-R scores were associated with faster TUG (β=−0.279, p<0.05) and 9HPT (right β=−0.257, p<0.05; left β=−0.302, p=0.05) and inversely with dependency (mRS=3–5, OR 0.88, 95% CI 0.80 to 0.97). We adjusted analyses for demographic, stroke and known risk factors. In-person and remote assessments were highly correlated. Conclusions Cognitive, physical impairments and depression are common and interrelated 3 years after minor stroke. Cognitive and physical impairments require rehabilitation after minor stroke and argue for better integration of stroke and dementia services.
Original languageEnglish
Pages (from-to)436-443
Number of pages8
JournalJournal of Neurology, Neurosurgery & Psychiatry
Volume90
Issue number4
Early online date15 Dec 2018
DOIs
Publication statusPublished - 2019

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Keywords

  • activities of daily living cognition dependency stroke walking speed Heart, Stroke Scotland, which funded the study. JMW reports grants from Chest, Heart, Stroke Scotland, grants from the Sackler Foundation, European Union Horizon 2020 grant No 666881, 'SVDs@target', Fondation Leducq, UK Medical Research Council, Stroke Association, Alzheimer's Society and British Heart Foundation.
  • Stroke
  • Activities of daily living
  • Cognition
  • Dependency
  • Walking speed
  • BATTERY
  • DISORDERS
  • RISK
  • IMPAIRMENT
  • INTELLIGENCE
  • IMPACT
  • MOTOR RECOVERY
  • ACE-R
  • SCALE
  • MENTAL-STATE

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery

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