title: Profile and determinants of vascular cognitive impairment in African stroke survivors: the CogFAST Nigeria Study.
abstract: OBJECTIVE
  Sub-Saharan Africa faces a potential epidemic of non-communicable diseases including stroke and dementia but little is known about the burden of stroke-related cognitive dysfunction. We assessed the baseline profile and factors associated with vascular cognitive impairment (VCI) in stroke survivors participating in the Cognitive Function After STroke (CogFAST) Nigeria Study.
  
  
  METHODS
  We recruited 217 subjects (>45 years old) comprising 143 stroke survivors and 74 demographically matched stroke-free healthy controls. We obtained demographic, clinical and lifestyle information and assessed the cognitive status of the subjects at baseline three months after stroke. Standard neuropsychological tests included the Vascular Neuropsychological Battery, which assessed executive function/mental speed, memory, language, and visuospatial/visuoconstructive functioning. Cognitive impairment and dementia were defined based on the AHA/ASA VCI guidelines and the DSM IV criteria.
  
  
  RESULTS
  Among the stroke survivors (mean ag e= 60.4+9.5 years, 43.4% female, mean number of years of education = 9.4+5.6 years, median modified Rankin score = 2), 57 (39.9%) had cognitive impairment no dementia while 12 (8.4%) were demented at baseline. Multivariate analysis revealed that older age [OR = 1.05 (1.00-1.09)], low education [OR = 5.09 (2.17-11.95)], pre-stroke cognitive decline [OR = 4.51 (1.20-16.88)] and medial temporal lobe atrophy [OR = 2.25 (1.16-4.35)] were independently associated with cognitive dysfunction whereas pre-stroke daily intake of fish [p = 0.022, OR = 0.39 (0.15-0.89)] was inversely associated.
  
  
  CONCLUSIONS
  These results suggest a high frequency of early VCI in older Nigerian stroke survivors. Apart from aging, associated neurodegeneration and cognitive decline, educational level and pre-stroke diet particularly fish consumption were identified as modifiable factors. This emphasizes the vital role of education and healthy nutrition in building reserves to ameliorate cognitive dysfunction after stroke.
authors.affiliation: Division of Neurology, Department of Medicine, Federal Medical Center Abeokuta, Nigeria; Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Rufus O
authors.initials: RO
authors.lastname: Akinyemi
authors.affiliation: Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Allan
authors.affiliation: Department of Medicine, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Mayowa O
authors.initials: MO
authors.lastname: Owolabi
authors.affiliation: Department of Epidemiology and Medical Statistics, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Akinyemi
authors.affiliation: Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Godwin
authors.initials: G
authors.lastname: Ogbole
authors.affiliation: Division of Neurology, Department of Medicine, Federal Medical Center Abeokuta, Nigeria.
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ajani
authors.affiliation: Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Firbank
authors.affiliation: Department of Medicine, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: raj.kalaria@ncl.ac.uk.
authors.forename: Raj N
authors.initials: RN
authors.lastname: Kalaria
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004032:Diet; D004493:Education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D017741:Survivors
keywords: Africa; Neuroimaging; Neuropsychology; Stroke; Vascular cognitive impairment; Vascular dementia