Long-Term Outcomes in Stroke Patients with Cognitive Impairment: A Population-Based Study Majed Obaid, Clare Flach, Iain Marshall, Charles D. A. Wolfe, and Abdel Douiri Presentan: Supervisor: Departemen Neurologi Medical Faculty oof Syiah Kuala University / Zainoel Abidin General Public Hospital INTRODUCTION • Stroke continues to be a major public health problem affecting> 10 million people annually worldwide. • One in four patients dies within one month of a stroke • Half of sufferers depend on other people to carry out their daily activities. Stroke causes cognitive deficits, but is still often overlooked and covered up by severe physical disabilities INTRODUCTION Cardiovascular disease is the second most common cause of cognitive impairment. • A quarter of individuals had cognitive impairment at three months after their first stroke and remained at this level for up to 10 years The term "vascular cognitive impairment" (VCI) replaces the term "vascular dementia". Instruments: - Mini-Mental State Examination (MMSE) score, - Montreal Cognitive Assessment Scale (MoCA) score - Abbreviated Mental Test (AMT) • The aim of this study was to determine how post-stroke cognitive impairment and cognitive function changes between stroke onset and three months after stroke were associated with long-term stroke outcomes. • The outcomes considered in this study were functional dependence, mortality, depression and institutionalization in the hospital or nursing home, up to five years after a stroke. METHODS Study Population •Data from the South London Stroke Register (SLSR). •Data collected between January 1995 and December 2018. Case •All patients with a suspected diagnosis of stroke or transient ischemic attack. METHODS • Stroke continues to be a major public health problem affecting> 10 million people annually worldwide. • One in four patients dies within one month of a stroke • Half of sufferers depend on other people to carry out their daily activities. STATISTIC ANALYSIS • Poisson multivariable regression models with strong SD of each outcome in cognitive impairment were constructed in the complete case analysis, to determine the RRs of each outcome at one and five years. • Change in cognitive impairment at three months after the stroke index was calculated on a continuous scale (MMSE / AMT) and was defined as a 10% decrease or increase and remained unchanged from measurement at seven days. ANALISIS STATISTIK Multivariable models were adapted for • • • • • • • stroke age onset, age, gender, ethnic, socioeconomic status, stroke subtype, previous diagnosis of ischemic attack, • hypertension, • diabetes mellitus transient • • • • • • • myocardial infarction, atrial fibrillation, smoking status, stroke severity measure (GCS), motor deficit, vascular risk factors, basic neuropsychological or physical problems, • dementia before stroke and stroke recurrence RESULTS: Assessment of cognitive function on the stroke index and at three months after stroke RESULTS: Assessment of cognitive function on the stroke index and at three months after stroke RESULTS: Assessment of cognitive function on the stroke index and at three months after stroke RESULTS: One year outcome with seven days of cognitive impairment RESULTS: One year outcome with seven days of cognitive impairment RESULTS: Baseline measures of change in cognitive impairment between seven days and three months RESULTS: Baseline measures of change in cognitive impairment between seven days and three months RESULTS: One-year outcome with changes in cognitive function between seven days and three months DISCUSSION • The frequency of post-stroke cognitive impairment is comparable to previous studies, which is about one third of sufferers. • Cognitive impairment after stroke is associated with worsening long-term stroke outcome including mortality, depression, and institutional dependence. DISCUSSION • Early deterioration in cognitive function in the first three months after stroke was associated with negative stroke outcomes. • Case-fatality rates among cognitive impaired versus cognitively well-reported stroke patients one, three and four years after stroke were 14% versus 4%, 34% versus 22% and 50% versus 30%, respectively. DISCUSSION • Previous STUDI: stroke survivors with dementia were more often discharged to nursing homes and had a higher risk of dying for three months than stroke survivors without dementia (p <001). • This finding: cognitive impairment after stroke is common and increases the risk of death and physical dependence about twofold. DISCUSSION • Depression was a predictor of early post-stroke cognitive impairment, with up to six months of follow-up. • Early remission of depressive symptoms after stroke among patients led to improved cognitive function as measured by MMSE, from 23.3 (SD = 4.2) at stroke onset, increasing to 26.6 (SD = 3.5) at 3 months of follow-up and remaining less. more the same for up to two years There are several possible explanations for the bad results Cardiovascular risk factors Atrial fibrillation and hypertension tend to be more common in stroke patients with cognitive impairments than in patients who are cognitively intact. Mobilization factor Patients tend to skip treatment which can make secondary stroke prevention less effective and in turn result in a greater risk of stroke recurrence, death and disability. Limited Social Interaction Reduces their ability to cope with physical disabilities and increases the likelihood of social isolation and depression DISCUSSION • Care Quality Commission: “lack of access to rehabilitation for cognitive difficulties in their review of stroke services”. • Cognitive decline is not a direct cause of dependence or death, but it can lead to other problems. For example, remembering medications, appointments, and the ability to perform daily activities could affect this outcome. CONCLUSION Cognitive impairment is an indicator of the long-term impact of stroke. Post-stroke cognitive impairment can increase or worsen over time. About a third of stroke survivors get better, get worse or stay the same during the first three months after a stroke. Early cognitive decline is strongly associated with poor stroke outcomes. Stroke patients should not stop going to health care, especially during the first three months because close monitoring to maintain cognitive abilities should be a focus for improving stroke outcomes.
