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Frequency of Cognitive Impairment Among Malaysian Elderly Patients Following First Ischaemic Stroke-A Case Control
Zeena Mohamed Fuad1, Hazlina Mahadzir1, Syed Zulkifli Syed Zakaria2
1Department of Medicine, Universiti Kebangsaan Medical Centre, Kuala Lumpur, Malaysia.
Insights
Post-stroke cognitive impairment (PSCI) is common, with dementia affecting nearly half of patients within six months. Stroke significantly increases dementia risk by 7.2 times, highlighting the need for early intervention and support.
Area of Science:
- Neurology
- Geriatrics
- Public Health
Background:
- Stroke is a leading global cause of cognitive impairment and dementia.
- Understanding the prevalence and risk factors of post-stroke cognitive impairment (PSCI) is crucial.
Purpose of the Study:
- To determine the frequency of PSCI at 1, 3, and 6 months post-first ischemic stroke.
- To compare PSCI rates in stroke patients versus age-matched controls.
- To identify predictors of post-stroke dementia.
Main Methods:
- A cohort study involving 32 patients (>60 years) with first ischemic stroke and 32 age-matched controls.
- Montreal Cognitive Assessment (MoCA) administered at 1, 3, and 6 months post-stroke.
- Mild PSCI defined as MoCA <26; moderate PSCI (post-stroke dementia) as MoCA <22.
Main Results:
- Post-stroke dementia prevalence was 37.5% at 1 month, increasing to 48.4% by 6 months.
- Mild PSCI affected 21.6% at 1 month, rising to 48% by 3 months.
- Stroke patients had a 7.2-fold increased risk of dementia at 6 months (OR 7.23, adjusted for education).
Conclusions:
- PSCI is highly prevalent, manifesting as early as one month after stroke.
- Stroke significantly elevates the risk of developing dementia.
- Years of education emerged as an independent protective factor against post-stroke dementia.
Abstract:
Background: Stroke is highly prevalent globally and is an important cause of cognitive impairment and dementia. Aims: We determined the frequency of post-stroke cognitive impairment (PSCI) at 1, 3, and 6 months among patients with first clinical ischemic stroke compared to risk and age-matched controls. Methods: This study involved 32 cases and 32 controls, and was conducted over 6 months. Cases were inpatients aged >60 with first clinical ischemic stroke. Controls were age-matched subjects without prior stroke. Montreal Cognitive Assessment (MoCA) was performed in all patients at 1, 3, and 6 month post stroke. A MoCA score of <26 was used for mild PSCI and <22 for moderate PSCI (post stroke dementia). Results: Post-stroke dementia was detected in 12 patients (37.5%) at 1st month, in 13 (40.6%) at 3rd month and 15 (48.4%) at 6th months. Mild PSCI was present in 7 patients (21.6%) at 1 month, 16 patients (50%) at 3 months, and 15 patients (48%) at 6 months. The odds ratio (OR) for post-stroke dementia was 3.2 (95%CI 0.98-10.68; p = 0.05) at 1 month; 3.69(95% CI 1.13-12.11; p = 0.031) at 3 months, and 4.88 (95% CI 1.49-15.99; p = 0.009) at 6 months. Years of education was an independent predictor for dementia (OR 0.60; p = 0.046). The OR for post-stroke dementia at 6th month was 7.23 with education level adjusted (95%CI 1.46-35.86, p = 0.015). Conclusion: The frequency of PSCI was high as early as 1 month after stroke. Stroke alone conferred a 7.2 times risk for post-stroke dementia compared to controls.
