Maya Penkova DANOVSKA, Margarita Lubomirova ALEXANDROVA

Cognitive impairment one year after ischemic stroke: predictorsand dynamics of significant determinants

Background/aim: Evidence suggests that the risk for dementia increases after stroke. This study investigated the dynamics of the neurological and cognitive status of patients with no baseline dementia over a 1-year period after ischemic stroke. Materials and methods: We examined 47 ischemic stroke patients admitted within 48 h of ictus. Their neurological and cognitive statuses, blood biochemical parameters, and microalbuminuria levels were prospectively evaluated over a 1-year period post-stroke. Results: A more severe neurological deficit was found in the cognitively impaired patients (P = 0.003). The NIHSS score over a 1-year follow-up period improved only in patients with normal cognition (P = 0.000). Time-varying dynamics of the MMSE score were observed in both patient groups (P = 0.000). Age (Р = 0.000), education (Р = 0.004), sex (Р = 0.041), history of diabetes (Р = 0.045), and serum high sensitive C-reactive protein (hs-CRP) on admission (Р = 0.003) were significant determinants of cognitive decline 1 year after a stroke. The albumin-to-creatinine ratio was high during the whole follow-up period in the cognitively impaired group after adjusting for sex and age (P = 0.010). Binary logistic regression showed that hs-CRP (Р = 0.013) and age (Р = 0.010) were independent predictors of patients cognitive status 1 year after stroke. Conclusion: The level of inflammatory markers could be considered as an additional criterion of long-term cognitive impairment.

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1. Stephens S, Kenny RA, Rowan E, Allan L, Kalaria RN, Bradbury M, Ballard CG. Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke. Int J Geriatr Psych 2004; 19: 1053-1057.
2. Knopman DS, Roberts RO, Geda YE, Boeve BF, Pankratz VS, Cha RH, Tangalos EG, Ivnik RJ, Petersen RC. Association of prior stroke with cognitive function and cognitive impairment: a population-based study. Arch Neurol-Chicago 2009; 66: 614- 619.
3. Ivan CS, Seshadri S, Beiser A, Au R, Kase CS, Kelly-Hayes M, Wolf PA. Dementia after stroke. The Framingham study. Stroke 2004; 35: 1264-1269.
4. Desmond DW, Moroney JT, Sano M, Stern Y. Incidence of dementia after ischemic stroke. Results of a longitudinal study. Stroke 2002; 33: 2254-2260.
5. Nys GM, van Zandvoort MJ, de Kort PL, Jansen BP, de Haan EH, Kappelle LJ. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis 2007; 23: 408-416.
6. Kuo HK, Yen CJ, Chang CH, Kuo CK, Chen JH, Sorond F. Relation of C-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol 2005; 4: 371-380.
7. Rothenburg LS, Herrmann N, Swardfager W, Black SE, Tennen G, Kiss A, Gladstone DJ, Ween J, Snaiderman A, Lanctôt KL. The relationship between inflammatory markers and post stroke cognitive impairment. J Geriatr Psych Neur 2010; 23: 199-205.
8. Hamilton M. A rating scale for depression. J Neurol Neurosur Ps 1960; 23: 56-62.
9. Dominici R, Luraschi P, Franzini C. Measurement of C-reactive protein: two high sensitivity methods compared. J Clin Lab Anal 2004; 18: 280-284.
10. Johns KW, Robinson CE, Wilson IM, Billington EO, Bondy GP, Tildesley HD. Does the albumin:creatinine ratio lack clinical utility in predicting microalbuminuria? British Columbia Medical Journal 2006; 48: 399-403.
11. Serrano S, Domingo J, Rodríguez-Garcia E, Castro MD, del Ser T. Frequency of cognitive impairment without dementia in patients with stroke. A two-year follow-up study. Stroke 2007; 38: 105-110.
12. Wang Q, Tang XN, Yenari MA. The inflammatory response in stroke. J Neuroimmunol 2007; 184: 53-68.
13. Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden dysfunctioning in subacute stroke. Stroke 2009; 40: 2473-279.
14. Saxena SK. Prevalence and correlates of cognitive impairment in stroke patients in a rehabilitation setting. International Journal of Psychosocial Rehabilitation 2006; 10: 37-47.
15. Whalley LJ, Deary IJ, Appleton CL, Starr JM. Cognitive reserve and the neurobiology of cognitive aging. Ageing Res Rev 2004; 3: 369-382.
16. Winocur G, Moscovitch M, Stuss D. Explicit and implicit memory in the elderly: evidence for double dissociation involving medial temporal- and frontal-lobe functions. Neuropsychology 1996; 10: 57-65.
17. Straub RH, Cutolo M, Zietz B, Schölmerich J. The process of aging changes the interplay of the immune, endocrine and nervous systems. Mech Ageing Dev 2001; 122: 1591-1611.
18. Xu G, Zhou Z, Zhu W, Fan X, Liu X. Plasma C-reactive protein is related to cognitive deterioration and dementia in patients with mild cognitive impairment. J Neurol Sci 2009; 284: 77-80.
19. Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 2010; 9: 895-905.