title: Relationship between poststroke cognition, baseline factors, and functional outcome: data from "efficacy of nitric oxide in stroke" trial.
abstract: BACKGROUND
  Poststroke cognitive impairment is common and identification of prognostic factors associated with it and its relationship with other functional outcomes may help in developing preventative strategies.
  
  
  METHODS
  Previously independent patients with acute stroke, enrolled into the ongoing "Efficacy of Nitric Oxide in Stroke" trial, were assessed by telephone on day 90 for cognitive impairment using modified versions of "Mini Mental State Examination" (MMSE-M) and "Telephone Instrument for Cognitive Status" (TICS-M) scales and category fluency. The relationship of cognitive impairment with baseline prognostic factors and other functional outcomes at day 90 were studied.
  
  
  RESULTS
  The analysis included 1572 patients, mean age 69 years (standard deviation, 12), and female 40%. By 90 days, 246 patients had died, and cognitive impairment was present in 38%. Increasing age, stroke severity, heart rate, and presence of cerebral atrophy on baseline neuroimaging were associated with cognitive impairment (all P < .001). Hypertension and atrial fibrillation were also associated with category fluency and MMSE-M, respectively. Cognition was significantly related to other functional outcomes, TICS-M with dependency (modified Rankin Scale, rs = -.562, P < .001); disability (Barthel Index, rs = .577, P < .001); mood (Zung Depression Score, rs = -.542, P < .001); and quality of life (Euro Quality of life-5 Descriptor, rs = .519, P < .001).
  
  
  CONCLUSIONS
  In previously independent individuals, cognitive impairment was common 3 months after stroke and related to increasing age, stroke severity, hypertension, atrial fibrillation, and cerebral atrophy on brain scanning. Cognition was related to dependency, disability, low mood, and quality of life. Hence, treatment directed toward reducing dependency might also reduce cognitive impairment.
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom.
authors: Sandeep
authors: S
authors: Ankolekar
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.
authors: Cheryl
authors: C
authors: Renton
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom; Leeds General Infirmary, Leeds, United Kingdom.
authors: Gillian
authors: G
authors: Sare
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.
authors: Sharon
authors: S
authors: Ellender
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors: Nikola
authors: N
authors: Sprigg
authors: Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Joanna M
authors: JM
authors: Wardlaw
authors: Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. Electronic address: philip.bath@nottingham.ac.uk.
authors: Philip M W
authors: PM
authors: Bath
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009569:Nitric Oxide / Q000627:therapeutic use*; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide
keywords: ENOS; Poststroke cognitive impairment; dementia; functional outcome; randomized controlled trial; stroke