title: Long-term cognitive impairment after first-ever ischemic stroke in young adults.
abstract: OBJECTIVE
  Up to 14% of all ischemic strokes occur in young adults (<50 years). Poststroke cognitive performance is a decisive determinant of their quality of life. However, virtually no studies report on cognition after young stroke, especially not on the long term. This long-term perspective is important because young patients have a long life expectancy during which they start forming a family, have an active social life, and make decisive career moves. We aimed to evaluate the long-term cognitive outcome.
  
  
  METHODS
  All consecutive patients between January 1, 1980, and November 1, 2010, with a first-ever young ischemic stroke were recruited for cognitive assessment, using a matched stroke-free population as a reference. Composite Z scores for 7 cognitive domains were calculated and the ANCOVA model was used (Bonferroni correction). A below average performance was defined as >1.0 SD below the age-adjusted mean of the controls and cognitive impairment as >1.5 SD.
  
  
  RESULTS
  Two hundred seventy-seven patients and 146 matched controls completed cognitive assessment (mean follow-up, 11.0 years, SD, 8.2; age, 50.9 years, SD, 10.3). Long-term cognitive outcome after an ischemic stroke was worse in most cognitive domains compared with a nonstroke population. Up to 50% of the patients had a below average performance or cognitive impairment. Deficits in processing speed, working memory, and attention were most common.
  
  
  CONCLUSIONS
  Even 11 years after ischemic stroke in young adults, a substantial proportion of patients must cope with permanent cognitive deficits. These results have implications for information given to patients and rehabilitation services.
authors: Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour. PO Box 9101, 6500 HB Nijmegen, the Netherlands.
authors: Pauline
authors: P
authors: Schaapsmeerders
authors: Noortje A M
authors: NA
authors: Maaijwee
authors: Ewoud J
authors: EJ
authors: van Dijk
authors: Loes C A
authors: LC
authors: Rutten-Jacobs
authors: Renate M
authors: RM
authors: Arntz
authors: Hennie C
authors: HC
authors: Schoonderwaldt
authors: Lucille D A
authors: LD
authors: Dorresteijn
authors: Roy P C
authors: RP
authors: Kessels
authors: Frank-Erik
authors: FE
authors: de Leeuw
mesh_terms: D000328:Adult; D001288:Attention; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D013997:Time Factors
keywords: cognitive impairment; cohort study; stroke in young adults