TY - JOUR
T1 - Cognitive trajectory in the first year after first-ever ischaemic stroke in young adults
T2 - the ODYSSEY study
AU - Schellekens, Mijntje M. I.
AU - Springer, Ravi C. S.
AU - Boot, Esther M.
AU - Verhoeven, Jamie I.
AU - Ekker, Merel S.
AU - van Alebeek, Mayte E.
AU - Brouwers, Paul J. A. M.
AU - Arntz, Renate M.
AU - van Dijk, Gert W.
AU - Gons, Rob A. R.
AU - van Uden, Inge W. M.
AU - den Heijer, Tom
AU - van Tuijl, Julia H.
AU - de Laat, Karlijn F.
AU - van Norden, Anouk G. W.
AU - Vermeer, Sarah E.
AU - van Zagten, Marian S. G.
AU - van Oostenbrugge, Robert J.
AU - Wermer, Marieke J. H.
AU - Nederkoorn, Paul J.
AU - van Rooij, Frank G.
AU - van den Wijngaard, Ido R.
AU - de Kort, Paul L. M.
AU - de Leeuw, Frank-Erik
AU - Kessels, Roy P. C.
AU - Tuladhar, Anil M.
PY - 2023
Y1 - 2023
N2 - Background Limited data exists on cognitive recovery in young stroke patients. We aimed to investigate the longitudinal course of cognitive performance during the first year after stroke at young age and identify predictors for cognitive recovery. Methods We conducted a multicentre prospective cohort study between 2013 and 2021, enrolling patients aged 18–49 years with first-ever ischaemic stroke. Cognitive assessments were performed within 6 months and after 1 year following the index event, covering seven cognitive domains. Composite Z-scores using normative data determined cognitive impairment (Z-score<−1.5). A Reliable Change Index (RCI) assessed cognitive recovery (RCI>1.96) or decline (RCI<−1.96). Results 393 patients (median age 44.3 years, IQR 38.4–47.2) completed cognitive assessments with a median time interval of 403 days (IQR 364–474) between assessments. Based on RCI, a similar proportion of patients showed improvement and decline in each cognitive domain, while the majority exhibited no cognitive change. Among cognitively impaired patients at baseline, improvements were observed in processing speed (23.1%), visuoconstruction (40.1%) and executive functioning (20.0%). Younger age was associated with better cognitive recovery in visuoconstruction, and larger lesion volume was related to cognitive recovery in processing speed. No other predictors for cognitive recovery were identified. Conclusions Cognitive impairment remains prevalent in young stroke even 1 year after the event. Most patients showed no cognitive change, however, recovery may have occurred in the early weeks after stroke, which was not assessed in our study. Among initially cognitively impaired patients, cognitive recovery is observed in processing speed, visuoconstruction and executive functioning. It is still not possible to predict cognitive recovery in individual patients.
AB - Background Limited data exists on cognitive recovery in young stroke patients. We aimed to investigate the longitudinal course of cognitive performance during the first year after stroke at young age and identify predictors for cognitive recovery. Methods We conducted a multicentre prospective cohort study between 2013 and 2021, enrolling patients aged 18–49 years with first-ever ischaemic stroke. Cognitive assessments were performed within 6 months and after 1 year following the index event, covering seven cognitive domains. Composite Z-scores using normative data determined cognitive impairment (Z-score<−1.5). A Reliable Change Index (RCI) assessed cognitive recovery (RCI>1.96) or decline (RCI<−1.96). Results 393 patients (median age 44.3 years, IQR 38.4–47.2) completed cognitive assessments with a median time interval of 403 days (IQR 364–474) between assessments. Based on RCI, a similar proportion of patients showed improvement and decline in each cognitive domain, while the majority exhibited no cognitive change. Among cognitively impaired patients at baseline, improvements were observed in processing speed (23.1%), visuoconstruction (40.1%) and executive functioning (20.0%). Younger age was associated with better cognitive recovery in visuoconstruction, and larger lesion volume was related to cognitive recovery in processing speed. No other predictors for cognitive recovery were identified. Conclusions Cognitive impairment remains prevalent in young stroke even 1 year after the event. Most patients showed no cognitive change, however, recovery may have occurred in the early weeks after stroke, which was not assessed in our study. Among initially cognitively impaired patients, cognitive recovery is observed in processing speed, visuoconstruction and executive functioning. It is still not possible to predict cognitive recovery in individual patients.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85183030576&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/38160045
U2 - https://doi.org/10.1136/jnnp-2023-332104
DO - https://doi.org/10.1136/jnnp-2023-332104
M3 - Article
C2 - 38160045
SN - 0022-3050
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
M1 - jnnp-2023-332104
ER -