title: Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study.
abstract: BACKGROUND
  Cognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. The aim of this study was to profile cognitive impairment of stroke survivors at six months, and to identify factors associated with cognitive impairment post-stroke, focusing on indicators of adequate secondary prevention and psychological function.
  
  
  METHODS
  Participants were assessed at six months following an ischaemic stroke as part of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke study (ASPIRE-S), which examined the secondary preventive and rehabilitative profile of patients in the community post-stroke. Cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA).
  
  
  RESULTS
  Two-hundred and fifty-six stroke patients were assessed at six months. Over half of the sample (56.6%) were found to have cognitive impairment, with significant associations between cognitive impairment and female sex (odds ratio (OR) = 1.6, 95% CI 1.01-2.57) and history of cerebrovascular disease (OR = 2.22, 95% CI 1.38-3.59). Treatment with antihypertensive medications (OR = .65, 95% CI .44-.96) and prescription of anticoagulant therapy (OR = .41, 95% CI .26-.68) were associated with reduced likelihood of cognitive impairment, however increasing number of total prescribed medications was moderately associated with poorer cognitive impairment (OR = 1.12, 95% CI 1.04-1.19).
  
  
  CONCLUSIONS
  Findings reveal levels of cognitive impairment at 6 months post-stroke that are concerning. Encouragingly, aspects of secondary prevention were identified that may be protective in reducing the incidence of cognitive impairment post-stroke. Neuropsychological rehabilitation post-stroke is also required as part of stroke rehabilitation models to meet the burden of post-stroke cognitive impairment.
authors: Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. lisamellon@rcsi.ie.
authors: Lisa
authors: L
authors: Mellon
authors: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. lindabrewer@beaumont.ie.
authors: Linda
authors: L
authors: Brewer
authors: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. halger@outlook.com.
authors: Patricia
authors: P
authors: Hall
authors: School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. fhorgan@rcsi.ie.
authors: Frances
authors: F
authors: Horgan
authors: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. davidwilliams@rcsi.ie.
authors: David
authors: D
authors: Williams
authors: Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, 2, Ireland. ahickey@rcsi.ie.
authors: Anne
authors: A
authors: Hickey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D017741:Survivors
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents