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Cognitive Impairment Predicts Poststroke Death In Long-Term Follow Up
  1. Niku Oksala (niku.oksala{at}tuubi1.net)
  1. Division of Vascular Surgery, Finland
    1. Hanna Jokinen (hanna.jokinen{at}helsinki.fi)
    1. University of Helsinki, Finland
      1. Susanna Melkas (susanna.melkas{at}hus.fi)
      1. Helsinki University Central Hospital, Finland
        1. Anni Oksala (anni.oksala{at}uta.fi)
        1. Tampere University, Finland
          1. Tarja Pohjasvaara (tarja.pohjasvaara{at}pp.inet.fi)
          1. HUCH, Finland
            1. Maria Hietanen (marja.hietanen{at}hus.fi)
            1. University of Helsinki, Finland
              1. Risto Vataja (risto.vataja{at}welho.com)
              1. Helsinki University Central Hospital, Finland
                1. Markku Kaste (markku.kaste{at}hus.fi)
                1. Helsinki University, Finland
                  1. Pekka Karhunen (pekka.karhunen{at}uta.fi)
                  1. Tampere University, Finland
                    1. Timo Erkinjuntti (timo.erkinjuntti{at}hus.fi)
                    1. HUCH, Finland

                      Abstract

                      Background: Poststroke global cognitive decline and dementia have been related to poor long term survival. Whether deficits in specific cognitive domains are associated with long term survival in ischemic stroke patients is not known in detail.

                      Methods: Consecutive acute stroke patients subjected to comprehensive neuropsychological evaluation were included in the study (N=409) and followed-up up to 12 years.

                      Results: In Kaplan-Meier analysis, impairments in following cognitive domains predicted poor poststroke survival (estimated years): executive functions (48.2%) (5.8 vs. 10.1 years, p<0.0001), memory (59.9%) (6.8 vs. 9.3 years, p=0.009), language (28.9%) (5.3 vs. 8.6 years, p=0.004), and visuospatial/constructional abilities (55.2%) (5.6 vs. 10.1 years, p<0.0001). Low MMSE ≤25 (30.5%) (4.4 vs. 9.3 years, p<0.0001), low education (<6 years) (31.8%) (6.4 vs. 8.2 years, p=0.003) and poor modified Rankin score (39.9%) (3.9 vs. 9.7 years, p<0.0001) were also related to poor survival. In Cox regression proportional hazards analyses including age, sex and years of education as covariates, deficits in executive functions (HR 1.59, p<0.0001), memory (HR 1.31, p=0.042), language (HR 1.33, p=0.036) and visuospatial/constructional abilities (HR 1.82, p<0.0001), were significant predictors of poor poststroke survival. Of these, executive functions (HR 1.33, p=0.040) as well as visuospatial/constructional abilities (HR 1.53, p=0.004) remained as significant predictors after addition of MMSE≤25 and poor modified Rankin score as covariates. Furthermore, cognitive impairment no dementia (CIND) was also an independent predictor of poor poststroke survival (HR 1.63, p=0.0123).

                      Conclusions: In patients with ischemic stroke, cognitive impairment particularly in executive functions, and visuospatial/constructional abilities relate to poor survival.

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