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Research paper
Functional, cognitive and physical outcomes 3 years after minor lacunar or cortical ischaemic stroke
  1. Caroline A McHutchison1,2,
  2. Vera Cvoro1,3,
  3. Stephen Makin1,4,
  4. Francesca M Chappell1,
  5. Kirsten Shuler1,
  6. Joanna M Wardlaw1,2,5,6
  1. 1 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  2. 2 Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
  3. 3 NHS Fife Victoria Hospital, Kirkcaldy, UK
  4. 4 Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
  5. 5 UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
  6. 6 Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Joanna M Wardlaw, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK; joanna.wardlaw{at}ed.ac.uk

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.

  • cognition
  • walking speed
  • activities of daily living
  • dependency
  • stroke

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Footnotes

  • Contributors CAM collected patient data at 3 years, analysed the data and drafted the manuscript. VC was involved in the 3-year follow-up data collection, analysis and reviewed the manuscript. SM performed the original patient recruitment and assessment and 1-year follow-up and reviewed the manuscript. FMC advised on the statistical analysis and interpretation of the data and reviewed the manuscript. KS managed the study data, assisted with the 1-year and 3-year follow-up data collection and reviewed the manuscript. JMW conceived the project, obtained funding, managed the project, advised on analysis and interpretation of the data, and reviewed and edited the manuscript. JMW is the guarantor of the project.

  • Funding Chest, Heart Stroke Scotland, Ref No: Res14/A157; NHS Research Scotland; The Wellcome Trust (WT088134/Z/09/A); the Row Fogo Charitable Trust; the European Union Horizon 2020, PHC-03-15, project No 666881, ‘SVDs@target’; the Fondation Leducq Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease, Ref No: 16 CVD 05; the Medical Research Council through the UK Dementia Research Institute; the Scottish Funding Council through the Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Initiative (http://www.sinapse.ac.uk).

  • Competing interests VC reports grants from NHS Research Scotland and Chest, 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.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Lothian Research Ethics committee (ref: 09/S1101/54) according to the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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