title: Changes in cognitive function over 3 years after first-ever stroke and predictors of cognitive impairment and long-term cognitive stability: the Erlangen Stroke Project.
abstract: OBJECTIVE
  Cognitive impairment (CI) is frequent after stroke, but data from population-based stroke cohorts on the natural course of CI are limited. The purpose of this study was to determine changes in cognitive status over 3 years after stroke.
  
  
  METHODS
  Data were collected from the Erlangen Stroke Project, an ongoing population-based stroke registry. The Mini-Mental State Examination (MMSE) for assessing global cognitive function was used; CI was defined as an MMSE score <24.
  
  
  RESULTS
  From February 1998 to January 2006, 630 patients with first-ever stroke were included. Prevalence rates of CI at 3 months, 1 and 3 years were 15, 13, and 12%. In multivariable analysis, stroke severity, i.e. Barthel index (p < 0.001), age (OR = 1.03; 95% CI = 1.00-1.05) and diabetes mellitus (OR = 2.03; 95% CI = 1.13-3.67) were associated with CI at 3 months. Recovery rate from CI at 3 months after stroke was found to be 31% over the following 3 years. Intact cognitive function rate was 71% over 3 years and inversely associated with age (OR = 0.96; 95% CI = 0.96-0.94) and stroke severity (p < 0.001).
  
  
  CONCLUSIONS
  CI is frequent among stroke survivors and associated with age, stroke severity, and diabetes mellitus, but recovery occurs in approximately one third of the patients over the course of 3 years. Factors affecting intact cognitive function over time are increasing age and stroke severity.
authors.affiliation: Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Berlin, Germany. thomas.liman@charite.de
authors.forename: T G
authors.initials: TG
authors.lastname: Liman
authors.forename: P U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: M
authors.initials: M
authors.lastname: Endres
authors.forename: A
authors.initials: A
authors.lastname: Flöel
authors.forename: S
authors.initials: S
authors.lastname: Schwab
authors.forename: P L
authors.initials: PL
authors.lastname: Kolominsky-Rabas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000175:diagnosis / Q000503:physiopathology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D003244:Consciousness Disorders / Q000175:diagnosis / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D013997:Time Factors