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Cognitive function in stroke survivors: A 10-year follow-up study.

H Delavaran1,2, A-C Jönsson2,3, H Lövkvist1,4

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Long-term post-stroke cognitive impairment (PSCI) is common, with higher odds of severe impairment in survivors. The Montreal Cognitive Assessment (MoCA) may better detect PSCI than the Mini-Mental State Examination (MMSE).

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Area of Science:

  • Neurology
  • Cognitive Science
  • Public Health

Background:

  • Post-stroke cognitive impairment (PSCI) significantly impacts patients and society.
  • Long-term studies on PSCI are limited, potentially due to assessment methods and selection bias.

Purpose of the Study:

  • To assess the prevalence of long-term PSCI in stroke survivors.
  • To compare the effectiveness of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in identifying PSCI.
  • To compare the cognitive function of long-term stroke survivors with non-stroke individuals.

Main Methods:

  • 10-year stroke survivors from the Lund Stroke Register (2001-2002) underwent MMSE and MoCA assessments.
  • PSCI was defined by MMSE scores <27 and/or MoCA scores <25; severe impairment by MMSE <23.
  • Stroke survivors were compared to age- and sex-matched non-stroke controls from the 'Good Ageing in Skåne' study using logistic regression.

Main Results:

  • Among 127 ten-year stroke survivors, PSCI prevalence was 46% (MMSE) and 61% (MoCA).
  • 35% of survivors with MoCA <25 had MMSE ≥27, indicating MoCA detected more cases.
  • Stroke survivors had significantly higher odds of severe cognitive impairment (MMSE <23) compared to controls (OR=2.5, P=.004).

Conclusions:

  • Long-term PSCI is prevalent in stroke survivors, with increased odds of severe impairment compared to the general population.
  • The Montreal Cognitive Assessment (MoCA) appears more sensitive than the Mini-Mental State Examination (MMSE) for detecting long-term PSCI.
  • Previous estimates of long-term PSCI burden may be underestimated.