Cognitive disorders in acute stroke: prevalence and clinical determinants.
BACKGROUND
Although cognitive impairment early after stroke is a powerful predictor of long-term functional dependence and dementia, little is known about the characteristics and determinants of cognitive dysfunction in acute stroke.


METHODS
We administered a neuropsychological examination covering 7 cognitive domains to 190 patients within 3 weeks after a first stroke. We also assembled lesion characteristics, clinical factors at admission, demographic characteristics and vascular risk factors. Multivariate logistic regression adjusted for age, gender and education was performed to examine determinants of acute cognitive impairment.


RESULTS
Overall, 74% of patients with a cortical stroke, 46% with a subcortical stroke and 43% with an infratentorial stroke demonstrated acute cognitive impairment. Disorders in executive functioning (39%) and visual perception/construction (38%) were the most common. The prevalence and severity of deficits in executive functioning, language, verbal memory and abstract reasoning was more pronounced following left compared to right cortical stroke (all p < 0.05). Intracerebral haemorrhage (OR = 5.6; 95% CI = 1.2-25.4) and cortical involvement of the stroke (OR = 3.6; 95%, CI = 1.3-9.9) were independent determinants of acute cognitive impairment, whereas premorbid moderate alcohol consumption exerted a protective effect (OR = 0.4; 95% CI = 0.1-1.1).


CONCLUSIONS
Cognitive impairment is common in the first weeks after stroke, with executive and perceptual disorders being the most frequent. Intracerebral haemorrhage, cortical involvement of the lesion and premorbid moderate alcohol consumption are independently associated with acute cognitive impairment.
Nys
G M S
GM
Laboratory for Neuropsychology, Department of Internal Medicine, Section Neurology, Ghent University, Ghent, Belgium. gudrun.nys@ugent.be
van Zandvoort
M J E
MJ
de Kort
P L M
PL
Jansen
B P W
BP
de Haan
E H F
EH
Kappelle
L J
LJ
D000208:Acute Disease; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000150:complications; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009483:Neuropsychological Tests; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000523:psychology