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The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study
Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected a...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374055/ https://www.ncbi.nlm.nih.gov/pubmed/34421786 http://dx.doi.org/10.3389/fneur.2021.678794 |
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author | Aam, Stina Gynnild, Mari Nordbø Munthe-Kaas, Ragnhild Saltvedt, Ingvild Lydersen, Stian Knapskog, Anne-Brita Ihle-Hansen, Hege Ellekjær, Hanne Eldholm, Rannveig Sakshaug Fure, Brynjar |
author_facet | Aam, Stina Gynnild, Mari Nordbø Munthe-Kaas, Ragnhild Saltvedt, Ingvild Lydersen, Stian Knapskog, Anne-Brita Ihle-Hansen, Hege Ellekjær, Hanne Eldholm, Rannveig Sakshaug Fure, Brynjar |
author_sort | Aam, Stina |
collection | PubMed |
description | Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI. |
format | Online Article Text |
id | pubmed-8374055 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83740552021-08-20 The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study Aam, Stina Gynnild, Mari Nordbø Munthe-Kaas, Ragnhild Saltvedt, Ingvild Lydersen, Stian Knapskog, Anne-Brita Ihle-Hansen, Hege Ellekjær, Hanne Eldholm, Rannveig Sakshaug Fure, Brynjar Front Neurol Neurology Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI. Frontiers Media S.A. 2021-08-05 /pmc/articles/PMC8374055/ /pubmed/34421786 http://dx.doi.org/10.3389/fneur.2021.678794 Text en Copyright © 2021 Aam, Gynnild, Munthe-Kaas, Saltvedt, Lydersen, Knapskog, Ihle-Hansen, Ellekjær, Eldholm and Fure. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Aam, Stina Gynnild, Mari Nordbø Munthe-Kaas, Ragnhild Saltvedt, Ingvild Lydersen, Stian Knapskog, Anne-Brita Ihle-Hansen, Hege Ellekjær, Hanne Eldholm, Rannveig Sakshaug Fure, Brynjar The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title | The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title_full | The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title_fullStr | The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title_full_unstemmed | The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title_short | The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study |
title_sort | impact of vascular risk factors on post-stroke cognitive impairment: the nor-coast study |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374055/ https://www.ncbi.nlm.nih.gov/pubmed/34421786 http://dx.doi.org/10.3389/fneur.2021.678794 |
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