title: Cognitive performance and poor long-term functional outcome after young stroke.
abstract: OBJECTIVE
  To investigate the influence of cognitive performance on long-term functional outcome after ischemic stroke (IS) in young adults aged 18 through 50 years (young IS).
  
  
  METHODS
  This study is part of a prospective cohort study among 277 stroke survivors with a young IS admitted to our department between January 1, 1980, and November 1, 2010. Functional outcome was assessed during follow-up between 2009 and 2012 with the modified Rankin Scale (mRS) and Instrumental Activities of Daily Living scale (IADL). Extensive neuropsychological investigation was performed. Logistic regression was used to calculate odds ratios (ORs) for a poor functional outcome (mRS >2 or IADL <8) for the 7 cognitive domains adjudicated for confounders. Cognitive function (continuous) as well as cognitive impairment (dichotomous) were studied.
  
  
  RESULTS
  Only decline in working memory (OR 0.3, 95% confidence interval [CI] 0.1-0.6) was associated with poor functional outcome on the mRS. Except for decline in processing speed (OR 0.5, 95% CI 0.3-0.8) and working memory (OR 0.4, 95% CI 0.2-0.7), no relation was found with poor functional outcome on IADL. Impairment in none of the individual cognitive domains was related to long-term functional outcome, although impairment in global cognitive function was related to a poor functional outcome on the IADL (OR 4.8, 95% CI 1.7-14.0).
  
  
  CONCLUSIONS
  On average, 11 years after young IS there was no clear relationship between long-term cognitive deficits and long-term functional outcome or IADL, stressing the need for further prospective studies with further development of sensitive measures of functional prognosis.
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Nathalie E
authors.initials: NE
authors.lastname: Synhaeve
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Schaapsmeerders
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Arntz
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Noortje A M
authors.initials: NA
authors.lastname: Maaijwee
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Loes C A
authors.initials: LC
authors.lastname: Rutten-Jacobs
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Henny C
authors.initials: HC
authors.lastname: Schoonderwaldt
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Lucille D A
authors.initials: LD
authors.lastname: Dorresteijn
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Paul L M
authors.initials: PL
authors.lastname: de Kort
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands.
authors.forename: Roy P C
authors.initials: RP
authors.lastname: Kessels
authors.affiliation: From the Department of Neurology, Centre for Neuroscience (N.E.S., P.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., R.P.C.K., F.-E.d.L.), and Centre for Cognition (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center; the Department of Neurology (N.E.S., P.L.M.d.K.), Elisabeth Hospital Tilburg, the Netherlands; the Department of Clinical Neurosciences (L.C.A.R.-J.), Neurology Unit, University of Cambridge, UK; and the Department of Neurology (L.D.A.D.), Medisch Spectrum Twente, the Netherlands. frankerik.deleeuw@radboudumc.nl.
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult