A case-controlled study of cognitive progression in Chinese lacunar stroke patients

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Abstract

Objective

(1) To determine and compare the rates of cognitive change using global and executive psychometric measures between lacunar stroke patients and matched controls and; (2) to identify features associated with cognitive changes in patients.

Methods

Sixty-one lacunar stroke patients and 35 demographically-matched controls were followed-up for 28.6 months (range 19.4–45.9 months) with psychometric assessments performed at baseline and follow-up.

Results

Lacunar stroke patients were more impaired than controls in general and executive functions at both time points. Both groups had similar stability in all psychometric tests. Patients, but not controls, exhibited a trend for improvement in general cognitive functions overtime (interaction term, p = 0.084). No patient who was non-demented at baseline became demented during the study period. Two (5.7%) and five (8.2%) incident cerebrovascular events occurred among the controls and patients, respectively. Linear regression analyses performed upon patients failed to identify any predictor for the cognitive change.

Conclusion

Similar to controls, cognition in lacunar stroke patients is stable during the first 2–3 years after the stroke. There maybe a spontaneous improvement in general cognition overtime, but this awaits confirmation by future studies.

Introduction

Lacunar infarcts (LI) are small, deep cerebral infarcts commonly found in the basal ganglia, thalamus and subcortical white matter [1]. Small vessel disease (SVD), manifested as LI and white matter changes (WMC) [2], accounts for the most frequent subtype of vascular dementia (VaD) [3]. Compared to Caucasians, lacunar stokes are more prevalent among Asians, including Chinese [4]. Although mortality in lacunar stroke in the short term is generally lower than that of other ischemic stroke subtypes [5], clinical and epidemiological studies have demonstrated close relationships between LI and cognitive impairment. First, lacunar strokes are commonly associated with cognitive decline in the early post-stroke period [6], [7]. Second, LI conferred increased risk for long-term cognitive decline and development of dementia, even in the absence of clinical strokes [8]. Third, LI may interact with [9], or add to [10], the effects of concomitant neurodegenerative pathology to enhance the clinical expression of dementia. Given these observations, longitudinal data on cognitive outcome are particular relevant to the management and healthcare planning for patients with lacunar stroke because of their relatively better survival at least in the first 2–3 years after stroke [5]. A number of studies examined the long-term cognitive progression among lacunar stroke patients and all of these studies were done on Caucasian subjects [11], [12], [13], [14]. To the best of our knowledge, such data is not yet available from Chinese lacunar stroke patients.

In our previous study we showed that 52% of our cohort of lacunar stroke patients experienced cognitive decline 3 months post-stroke [7]. We prospectively followed this cohort with repeated neuropsychological assessments. The objectives of this longitudinal study are to (1) determine the rate of cognitive change using commonly used general and executive cognitive measures and compare these changes with that of demographically matched controls; and (2) to identify the features associated with these changes among this cohort of lacunar stroke patients.

Section snippets

Materials and methods

We recruited a consecutive cohort of 75 Chinese lacunar stroke patients admitted to the acute stroke unit of the Prince of Wales Hospital in Hong Kong between January and July 2002. We included only patients with lacunar stroke due to pure SVD. Patients with lacunar stroke due to extracranial or intracranial large artery disease or cardioembolic disease were excluded. Intracranial large artery disease was considered to be relevant if the stenosis was at least moderate (≥50%) in severity and if

Results

There were no significant changes between baseline and follow-up assessments in any cognitive test or in the global composite score within both groups. Controls performed significantly better than patients in all cognitive measures at both time points. Controls and patients had similar rates of change in MMSE, MDRS I/P and the global composite score. On the ADAS-cog, there was a trend for lacunar stroke patients to improve relative to controls (p = 0.084). Details of ANCOVA for the 3 psychometric

Discussion

This is the first case-controlled longitudinal stroke registry study that examined the cognitive progression among Chinese lacunar stroke patients utilizing both general and executive psychometric measures. This study differs from previous studies [8], [28] that it involved consecutive patients admitted for clinical lacunar strokes, and prior case-controlled studies that examined the long-term cognitive progression in stroke patients with detailed breakdown of cognitive domains did not provide

Conflict of interest

The authors have reported no conflicts of interest.

Acknowledgements

Supported by Earmarked Research Grant CUHK 4069/02M and CUHK 4317/04 from the Hong Kong Research Grants Council and the research fund from the Department of Medicine and Therapeutics, The Chinese University of Hong Kong.

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