Hyperglycemia and cognitive outcome after ischemic stroke.
BACKGROUND
Post-stroke hyperglycemia (HG) is associated with poor physical recovery, in particular in patients with cortical stroke. We tested whether HG is also associated with cognitive impairment after ischemic stroke.


METHODS
We recruited patients from a prospective consecutive cohort with a first-ever supratentorial infarct. Neuropsychological examination included abstract reasoning, verbal memory, visual memory, visual perception and construction, language, and executive functioning. We related HG (glucose >7.0 mmol/L) to cognition and functional outcome (modified Barthel Index) at baseline and after 6-10 months, and to neurological deficit (National Institutes of Health Stroke Scale) and infarct size at baseline. In additional analyses cortical and subcortical infarcts were considered separately.


RESULTS
Of 113 patients, 43 had HG (38%) and 55 had cortical infarcts (49%). Follow-up was obtained from 76 patients (68%). In the acute phase, in patients with cortical infarcts HG was associated with impaired executive function (B=-0.65; 95% confidence limits (CL): -1.3-0.00; p<0.05), larger lesion size (p<0.01), and more severe neurological deficits (p<0.01). These associations were not observed in patients with subcortical infarcts and the association between HG and cognitive functioning at follow-up was not significant in either group.


CONCLUSIONS
In first-ever ischemic stroke, HG was not associated with impaired cognition after 6-10 months. In the acute phase of stroke HG was associated with impaired executive function, but only in patients with cortical infarcts.
Kruyt
N D
ND
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, The Netherlands. N.D.Kruijt@amc.uva.nl
Nys
G M S
GM
van der Worp
H B
HB
van Zandvoort
M J E
MJ
Kappelle
L J
LJ
Biessels
G J
GJ
D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002545:Brain Ischemia / Q000150:complications; D003072:Cognition Disorders / Q000209:etiology*; D016001:Confidence Intervals; D003863:Depression / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D016017:Odds Ratio; D020521:Stroke / Q000150:complications* / Q000209:etiology
D001786:Blood Glucose