Long-Term Outcomes in Stroke Patients with Cognitive Impairment: A Population-Based Study
Majed Obaid, Clare Flach, Iain Marshall, Charles Wolfe, Abdel Douiri
Abstract
This study assesses five year outcomes of patients with cognitive deficits within the first three months after stroke. Population-based data from the South London Stroke Register between 1995 and 2018 were studied. Cognitive function was assessed using the Abbreviated-Mental-Test or Mini-Mental-State-Examination. Multivariable Poisson regression models with robust standard errors were constructed, to evaluate relative risks (RRs) and associations between post-stroke deterioration in cognitive function during the first three months on dependency, mortality, depression and institutionalisation. A total of 6504 patients with first-ever strokes were registered with a mean age of 73 (SD: 13.2). During the first three months post-stoke, approximately one-third of these stroke survivors either cognitively improved (37%), deteriorated (30%) or remained unchanged (33%). Post-stroke cognitive impairment was associated with increases, in five years, of the risks of mortality, dependency, depression and being institutionalised by RRs 30% (95% confidence interval: 1.1-1.5), 90% (1.3-2.6), 60% (1.1-2.4) and 50% (1.1-2.3), respectively. Deterioration in cognitive function by 10% or more between seven days and three months was associated with an approximate two-fold increased risk in mortality, dependency, and being institutionalised after one year, compared to stable cognitive function; RRs 80% (1.1-3.0), 70% (1.2-2.4) and two-fold (1.3-3.2), respectively. Monitoring further change to maintain cognitive abilities should be a focus to improve outcomes.