The impact of early-life intelligence quotient on post stroke cognitive impairment

Stephen D J Makin, Fergus N Doubal, Kirsten Shuler, Francesca M Chappell, Julie Staals, Martin S. Dennis, Joanna M Wardlaw

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods: We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1-3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke's Cognitive Examination-Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). Results: We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56-74) years, 36/157 (23%) patients had a Addenbrooke's Cognitive Examination-Revised score <82 at one to three months, 29/151 (19%) had a Addenbrooke's Cognitive Examination-Revised <82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). Discussion: This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion: Pre-morbid intelligence should be considered in future studies of post-stroke cognition.
Original languageEnglish
Pages (from-to)145-156
Number of pages12
JournalEuropean Stroke Journal
Volume3
Issue number2
Early online date8 Jan 2018
DOIs
Publication statusPublished - 1 Jun 2018

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Intelligence
Stroke
Odds Ratio
Confidence Intervals
Reading
Hypertension
Education
Cognitive Dysfunction
Aptitude
National Institutes of Health (U.S.)
Observational Studies
Magnetic Resonance Imaging

Keywords

  • National Adult Reading Test
  • stroke
  • intelligence quotient
  • lacunar stroke
  • post-stroke dementia

Cite this

Makin, S. D. J., Doubal, F. N., Shuler, K., Chappell, F. M., Staals, J., Dennis, M. S., & Wardlaw, J. M. (2018). The impact of early-life intelligence quotient on post stroke cognitive impairment. European Stroke Journal , 3(2), 145-156. https://doi.org/10.1177/2396987317750517

The impact of early-life intelligence quotient on post stroke cognitive impairment. / Makin, Stephen D J; Doubal, Fergus N; Shuler, Kirsten; Chappell, Francesca M; Staals, Julie ; Dennis, Martin S.; Wardlaw, Joanna M.

In: European Stroke Journal , Vol. 3, No. 2, 01.06.2018, p. 145-156.

Research output: Contribution to journalArticle

Makin, SDJ, Doubal, FN, Shuler, K, Chappell, FM, Staals, J, Dennis, MS & Wardlaw, JM 2018, 'The impact of early-life intelligence quotient on post stroke cognitive impairment', European Stroke Journal , vol. 3, no. 2, pp. 145-156. https://doi.org/10.1177/2396987317750517
Makin, Stephen D J ; Doubal, Fergus N ; Shuler, Kirsten ; Chappell, Francesca M ; Staals, Julie ; Dennis, Martin S. ; Wardlaw, Joanna M. / The impact of early-life intelligence quotient on post stroke cognitive impairment. In: European Stroke Journal . 2018 ; Vol. 3, No. 2. pp. 145-156.
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N2 - Background: Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods: We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1-3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke's Cognitive Examination-Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). Results: We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56-74) years, 36/157 (23%) patients had a Addenbrooke's Cognitive Examination-Revised score <82 at one to three months, 29/151 (19%) had a Addenbrooke's Cognitive Examination-Revised <82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). Discussion: This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion: Pre-morbid intelligence should be considered in future studies of post-stroke cognition.

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