Long-term cognitive outcome of ischaemic stroke in young adults

Long-term prognosis in terms of cognition in young stroke patients is very important because these patients usually still have a long life expectancy and rather extensive daily life demands. However, little is known on cognitive deficits in these patients. We aimed to evaluate cognitive function in young stroke patients (<50 years) after long-term follow-up.

Young adults with first-ever ischaemic stroke admitted to St. Elisabeth Hospital or the TweeSteden Hospital, Tilburg, the Netherlands, between January 2000 and December 2010 were included. Patients with severe aphasia or pre-existent cognitive impairment were excluded. Cognitive functioning was assessed using a neuropsychological examination focussing on the following cognitive domains: visual perception, visual and verbal memory, mental speed, and executive functioning. Raw scores were compared to the scores of 61 controls using a multivariate analysis of variance with adjustment for education level.

The 96 participants (median age at index event 43.0 years; 45.8% male) performed worse than controls on the Stroop Color-Word Test Part 1 (p < 0.001) and on the Symbol-Digit Substitution Task (p < 0.001), both assessing mental speed. Patients had significantly lower scores on the learning slope of the Word Pair test (p = 0.002) assessing verbal memory. Patients performed better on the Rey-Osterrieth Complex Figure than controls (p < 0.001).

In young patients with ischaemic stroke, mental slowness is present even up to 10 years after stroke. When counselling these patients, doctors should actively try to assess the presence of cognitive deficits, also after a long period of follow-up.