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Improving cognitive outcomes for pediatric stroke
Mardee Greenham1, Vicki Anderson, Mark T Mackay
1aClinical Sciences, Murdoch Childrens Research Institute bSchool of Psychological Sciences, University of Melbourne cDepartment of Psychology dDepartment of Neurology, Royal Children's Hospital eDepartment of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Pediatric stroke impacts cognition in up to half of survivors, affecting intelligence and executive functions. Children do not recover better than adults, and factors like stroke severity and comorbidities worsen outcomes.
Area of Science:
- Neurology
- Pediatric Medicine
- Neuroscience
Background:
- Pediatric stroke prevalence has increased 35% in the last 20 years.
- Contrary to popular belief, children do not exhibit superior recovery compared to adults after stroke.
- Cognitive deficits are a significant concern for pediatric stroke survivors.
Purpose of the Study:
- To review the impact of pediatric stroke on cognitive domains.
- To explore factors influencing cognitive outcomes in children after stroke.
- To highlight the need for better understanding and targeted rehabilitation strategies.
Main Methods:
- Literature review of studies on pediatric stroke and cognitive outcomes.
- Analysis of factors such as age at stroke, lesion characteristics, and comorbidities.
- Synthesis of findings on intellectual, executive, memory, and behavioral functions.
Main Results:
- Cognitive problems affect up to 50% of pediatric stroke survivors.
- Impairments are noted in intelligence quotient (IQ), particularly in performance domains.
- Executive functions, including attention and processing speed, are particularly vulnerable.
- Poorer cognitive outcomes are associated with younger age at stroke, larger infarcts, cortical/subcortical lesions, epilepsy, and physical comorbidities.
Conclusions:
- Pediatric stroke frequently leads to cognitive impairment, but specific deficits and predictors require further definition.
- Understanding outcomes is crucial for developing targeted, age-specific rehabilitation strategies.
- More research is needed to optimize cognitive recovery in pediatric stroke survivors.
Purpose Of Review:
The past 20 years have seen a 35% increase in prevalence of pediatric stroke. Contrary to widely held views, children do not recover better than adults. This review explores the impact of pediatric stroke on cognitive domains, including intellectual and executive functions, memory and behavior, and the influence of age, lesion characteristics, and comorbidities on outcome.
Recent Findings:
Cognitive problems occur in up to half of ischemic and hemorrhagic stroke survivors. Single-center studies have shown intelligence quotient scores skewed to the lower end of the average range, with greater impairment in performance than verbal domains. Executive function, such as attention and processing speed are particularly vulnerable to the effects of pediatric stroke. Age at stroke, larger infarct size, cortical/subcortical lesion location, epilepsy, and comorbid physical deficits are associated with poorer cognitive outcomes.
Summary:
Cognitive impairment occurs relatively frequently following pediatric stroke but the nature, severity, and predictors of specific deficits are not well defined. Improving understanding of outcomes following pediatric stroke is a key priority for families but a paucity of data limits the ability to develop targeted disease, and age-specific pediatric rehabilitation strategies to optimize cognitive outcomes following pediatric stroke.
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