The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke

Xiao-ling Liao,1 Li-jun Zuo,1 Ning Zhang,2 Yang Yang,2 Yue-song Pan,3 Xiang-long Xiang,3 Ling-yun Chen,4 Xia Meng,3 Hao Li,3 Xing-quan Zhao,1 Yi-long Wang,1 Chun-xue Wang,2 Jiong Shi,3 Yong-jun Wang1 On behalf of the Impairment of CognitiON and Sleep quality for patients after acute ischemic stroke or transient ischemic attack (ICONS) Investigators1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Neuropsychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 3National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Medicine, Eisai China INC, Shanghai, People’s Republic of ChinaCorrespondence: Yong-jun WangDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing 100070, People’s Republic of ChinaTel +86-10-59978350Fax +86-10-59973383Email yongjunwang@ncrcnd.org.cnBackground and Purpose: More and more evidence suggests that cognitive impairment (CI) after stroke is closely related to the quality of life of stroke patients. The primary aim of this study is to investigate the occurrence and longitudinal changes of CI at different stages after acute ischemic stroke (AIS) in Chinese patients.Methods: The data of this study come from the impairment of cognition and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients study (ICONS), a nationwide multicenter prospective registry that recruited consecutive AIS or transient ischemic attack in-hospital patients within 7 days after onset. Patients were followed for Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3m) and 12 months (12m). CI was defined as MoCA score≦22. No cognitive impairment (NCI) was defined as MoCA score> 22.Results: A total of 2432 AIS patients were enrolled in this study. Overall, 72.94% of patients were male and the average age was 60.95 years. Median National Institutes of Health Stroke Scale score was 3. The occurrence rate of CI was 52.38%, 35.55% and 34.16% at 2w, 3m and 12m. Among patients with CI at 2w and 3m, 39.9% and 27.9% of patients returned to NCI at next follow-up point. At 3m and 12m follow-up, there were also 9.6% and 12.7% new CI patients. The two cognitive items with the highest abnormal rate were “Delayed recall” (89.35%, 83.33% and 82.80%) and “Visuospatial/executive” (78.91%, 73.42% and 70.08%). The cognitive item with the highest percentage of improved patients was “Orientation” (60.91– 76.68%), and the cognitive item with the lowest percentage of improved patients was “Language” (35.85– 44.50%).Conclusion: CI had a relatively high occurrence at 2w to 12m after AIS. CI at 3m and 12m was significantly lower than that at 2w after stroke. The occurrence of abnormalities and recovery probability for different cognitive items also differed greatly.Keywords: cognitive impairment, ischemic stroke, longitudinal cohort study, occurrence