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J Neurol Neurosurg Psychiatry. 1994 February; 57(2): 202–207.
PMCID: PMC1072451

Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities.

Abstract

Cognitive function was examined in 227 patients three months after admission to hospital for ischaemic stroke, and in 240 stroke-free controls, using 17 scored items that assessed memory, orientation, verbal skills, visuospatial ability, abstract reasoning, and attentional skills. After adjusting for demographic factors with standardised residual scores in all subjects, the fifth percentile was used for controls as the criterion for failure on each item. The mean (SD) number of failed items was 3.4 (3.6) for patients with stroke and 0.8 (1.3) for controls (p < 0.001). Cognitive impairment, defined as failure on any four or more items, occurred in 35.2% of patients with stroke and 3.8% of controls (p < 0.001). Cognitive domains most likely to be defective in stroke compared with control subjects were memory, orientation, language, and attention. Among patients with stroke, cognitive impairment was most frequently associated with major cortical syndromes and with infarctions in the left anterior and posterior cerebral artery territories. Functional impairment was greater with cognitive impairment, and dependent living after discharge either at home or nursing home was more likely (55.0% with, v 32.7% without cognitive impairment, p = 0.001). In a logistic model examining the risks related to dependent living after stroke, cognitive impairment was a significant independent correlate (odds ratio, OR = 2.4), after adjusting for age (OR = 5.2, 80 + v 60-70 years) and physical impairment (OR = 3.7, Barthel index < or = 40 v > 40). It is concluded that cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention. The presence of cognitive impairment in patients with strike has important functional consequences, independent of the effects of physical impairment. Studies of stroke outcome and intervention should take into account both cognitive and physical impairments.

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Selected References

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  • Gresham GE, Phillips TF, Wolf PA, McNamara PM, Kannel WB, Dawber TR. Epidemiologic profile of long-term stroke disability: the Framingham study. Arch Phys Med Rehabil. 1979 Nov;60(11):487–491. [PubMed]
  • Wade DT, Skilbeck C, Hewer RL. Selected cognitive losses after stroke. Frequency, recovery and prognostic importance. Int Disabil Stud. 1989 Jan-Mar;11(1):34–39. [PubMed]
  • Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, Remien RH, Williams JB, Mohr JP, Hauser WA, et al. Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort. Neurology. 1992 Jun;42(6):1185–1193. [PubMed]
  • Stern Y, Andrews H, Pittman J, Sano M, Tatemichi T, Lantigua R, Mayeux R. Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. Arch Neurol. 1992 May;49(5):453–460. [PubMed]
  • Pittman J, Andrews H, Tatemichi T, Link B, Struening E, Stern Y, Mayeux R. Diagnosis of dementia in a heterogeneous population. A comparison of paradigm-based diagnosis and physician's diagnosis. Arch Neurol. 1992 May;49(5):461–467. [PubMed]
  • Skilbeck CE, Wade DT, Hewer RL, Wood VA. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983 Jan;46(1):5–8. [PMC free article] [PubMed]
  • Wade DT, Wood VA, Hewer RL. Recovery after stroke--the first 3 months. J Neurol Neurosurg Psychiatry. 1985 Jan;48(1):7–13. [PMC free article] [PubMed]
  • Buschke H, Fuld PA. Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology. 1974 Nov;24(11):1019–1025. [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
  • Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968 Jul;114(512):797–811. [PubMed]
  • Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The Stroke Data Bank: design, methods, and baseline characteristics. Stroke. 1988 May;19(5):547–554. [PubMed]
  • Damasio H. A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol. 1983 Mar;40(3):138–142. [PubMed]
  • Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991 May;41(5):685–691. [PubMed]
  • Granger CV, Sherwood CC, Greer DS. Functional status measures in a comprehensive stroke care program. Arch Phys Med Rehabil. 1977 Dec;58(12):555–561. [PubMed]
  • Wade DT, Skilbeck CE, Hewer RL. Predicting Barthel ADL score at 6 months after an acute stroke. Arch Phys Med Rehabil. 1983 Jan;64(1):24–28. [PubMed]
  • Kelly-Hayes M, Wolf PA, Kannel WB, Sytkowski P, D'Agostino RB, Gresham GE. Factors influencing survival and need for institutionalization following stroke: the Framingham Study. Arch Phys Med Rehabil. 1988 Jun;69(6):415–418. [PubMed]
  • DeJong G, Branch LG. Predicting the stroke patient's ability to live independently. Stroke. 1982 Sep-Oct;13(5):648–655. [PubMed]
  • Hom J, Reitan RM. Generalized cognitive function after stroke. J Clin Exp Neuropsychol. 1990 Oct;12(5):644–654. [PubMed]
  • Adams RL, Boake C, Crain C. Bias in a neuropsychological test classification related to education, age, and ethnicity. J Consult Clin Psychol. 1982 Feb;50(1):143–145. [PubMed]
  • Wade DT, Parker V, Langton Hewer R. Memory disturbance after stroke: frequency and associated losses. Int Rehabil Med. 1986;8(2):60–64. [PubMed]

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