title: Cognitive performance following lacunar stroke in Spanish-speaking patients: results from the SPS3 trial.
abstract: BACKGROUND
  Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients.
  
  
  OBJECTIVE
  The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients.
  
  
  METHODS
  The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial.
  
  
  RESULTS
  Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ≤5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years = 1.52, confidence interval = 1.35-1.71), lower education (odds ratio 0-4 years = 1.23, confidence interval = 0.90-1.67), being a Latin American resident (odds ratio = 1.31, confidence interval = 0.87-1.98), and post-stroke disability (odds ratio Barthel Index <95 = 1.89, confidence interval = 1.43-2.50) were independently associated with mild cognitive impairment.
  
  
  CONCLUSIONS
  Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.
authors.affiliation: Division of Neurology, School of Professional Psychology, Pacific University, Hillsboro, OR, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Jacova
authors.affiliation: Biostatistical Consultant, Minot, ND, USA.
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Pearce
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Roldan
authors.affiliation: Neurology and Neurosurgery National Institute, Mexico City, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arauz
authors.affiliation: Department of Neurology, Catholic University, Santiago, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Tapia
authors.affiliation: Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Costello
authors.affiliation: Department of Biostatics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Division of Neurology, Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
authors.affiliation: Division of Neurology, School of Professional Psychology, Pacific University, Hillsboro, OR, USA.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
mesh_terms: D000367:Age Factors; D000368:Aged; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007802:Language; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D055502:Secondary Prevention; D013030:Spain / Q000453:epidemiology; D059409:Stroke, Lacunar / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D014481:United States / Q000453:epidemiology
keywords: Hispanic; Spanish-speaking; cognitive function; cognitive impairment; lacunar stroke