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. 2022 May;12(5):e2571.
doi: 10.1002/brb3.2571. Epub 2022 Apr 14.

Multidomain cognitive dysfunction after minor stroke suggests generalized disruption of cognitive networks

Elisabeth B Marsh  1 , Sheena Khan  1 , Rafael H Llinas  1 , Keenan A Walker  2 , Jason Brandt  1   3
Affiliations

Multidomain cognitive dysfunction after minor stroke suggests generalized disruption of cognitive networks

Elisabeth B Marsh et al. Brain Behav. 2022 May.

Abstract

Objective: Although small strokes typically result in "good" functional outcomes, significant cognitive impairment can occur. This longitudinal study examined a cohort of patients with minor stroke to determine the pattern of deficits, evolution over time, and factors associated with outcome.

Methods: Patients admitted to the hospital with their first clinical minor stroke (NIH Stroke Scale [NIHSS] ≤ 10, absence of severe hemiparesis, aphasia, or neglect) were assessed at 1 month post-infarct, and a subset were followed over time (with 6- and 12-month evaluations). Composite scores at each time point were generated for global cognition, verbal memory, spatial memory, motor speed, processing speed, and executive function. Paired t-tests evaluated change in scores over time. Regression models identified factors associated with initial performance and better recovery.

Results: Eighty patients were enrolled, evaluated at 1 month, and prospectively followed. The average age of the participants was 62.3 years, and mean education was 13.5 years. The average stroke volume was 6.6 cc; mean NIHSS score was 2.8. At 1 month, cognitive scores were below the normative range and > 1 standard deviation below the patient's peak ("recovery") score for every cognitive domain, strongly suggesting that they were well below patients' prestroke baselines. Forty-eight patients followed up at 6 months, and 39 at 12 months. Nearly all (98%) patients significantly improved in global cognition (averaged across domains) between 1 and 6 months. Between 6 and 12 months, recovery was variable. Higher education, occupational class, and Caucasian race were associated with higher recovery scores for most domains.

Conclusions: Cognitive impairment across multiple domains is common following minor stroke regardless of infarct location, suggesting a global process such as network dysfunction that improves over 6 months. Degree of recovery can be predicted using baseline factors.

Keywords: cognition; dementia; minor stroke; outcomes; recovery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient T scores are significantly lower than the normative mean for all cognitive domains and improve over time
FIGURE 2
FIGURE 2
There were significant differences between 1‐month and recovery scores for all cognitive domains, as well as between 1 and 6 months, but not 6–12 months
FIGURE 3
FIGURE 3
There is a difference in the patterns between motor performance and other domains. p‐Values for univariate analyses were labeled as positive or negative based on the direction of the association and then log transformed so that a value of 1.3 corresponds to a p‐value of .05. Significant p‐values are designated by an asterisk
See this image and copyright information in PMC

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