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Published on: February 14, 2014
Effect of Age at Pediatric Stroke on Long-term Cognitive Outcome
Stephanie Abgottspon1, Qendresa Thaqi1, Leonie Steiner1
1From the Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics (S.A., Q.T., L.S., S.G., M.S., R.E.), Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism (S.A., R.E.), and Institute of Diagnostic and Interventional Neuroradiology (N.S.), Inselspital, Bern University Hospital, University of Bern; Graduate School for Health Sciences (S.A., L.S.) and Department of Psychology (Q.T.), University of Bern; and Pediatric Radiology (N.S.), University Children's Hospital Basel and University of Basel, Switzerland.
Insights
Pediatric arterial ischemic stroke impacts long-term cognition. Early childhood stroke (29 days to <6 years) poses the highest risk for cognitive deficits, affecting flexibility, processing speed, and verbal learning.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Pediatric arterial ischemic stroke (AIS) can lead to long-term cognitive sequelae.
- Understanding the impact of stroke timing on cognitive outcomes is crucial for identifying at-risk children.
Purpose of the Study:
- To investigate how age at the time of pediatric arterial ischemic stroke affects long-term cognitive outcomes.
- To identify specific age groups at higher risk for cognitive deficits after stroke.
Main Methods:
- A cross-sectional study compared cognitive function in pediatric AIS survivors (>2 years post-stroke) with healthy controls.
- Neuropsychological tests assessed intelligence, executive functions, processing speed, memory, fluency, and visual-motor skills.
- Patients were categorized by age at stroke: neonatal (0-28 days), early childhood (29 days to <6 years), and late childhood (≥6 to <16 years).
Main Results:
- Pediatric AIS survivors demonstrated significantly worse cognitive outcomes than controls.
- A nonlinear effect of age at stroke was observed, with early childhood stroke associated with poorer outcomes in cognitive flexibility, processing speed, and verbal learning.
- These findings were independent of lesion size and location.
Conclusions:
- Age at stroke is a critical determinant of long-term cognitive recovery in pediatric AIS.
- Children experiencing stroke in early childhood (29 days to <6 years) are particularly vulnerable to persistent cognitive impairments.
Background And Objectives:
To investigate the effect of age at pediatric arterial ischemic stroke on long-term cognitive outcome in order to identify patients particularly at risk for the development of long-term cognitive sequelae.
Methods:
This cross-sectional study included patients in the chronic phase of stroke (>2 years after stroke) previously diagnosed with neonatal or childhood arterial ischemic stroke and a control group. Participants with active epilepsy, severe learning difficulties, or behavioral problems hindering the cognitive assessment were excluded. Several cognitive domains, including intelligence, executive functions (working memory, inhibition, and cognitive flexibility), processing speed, memory, letter fluency, and visual-motor skills were assessed with neuropsychological tests. Cognitive long-term outcome was compared across patients after neonatal stroke (stroke between 0 and 28 days of life), early childhood stroke (stroke between 29 days and <6 years), and late childhood stroke (stroke between ≥6 and <16 years).
Results:
Fifty-two patients after neonatal or childhood arterial ischemic stroke (median age 15.3 years, interquartile range [IQR] 10.6-18.7) and 49 healthy controls (median age 13.6 years, IQR 9.8-17.2) met the inclusion criteria. Cognitive outcome was significantly worse in the pediatric stroke group compared to the control group. A nonlinear effect of age at stroke (irrespective of lesion size and lesion location) was found for cognitive flexibility, processing speed, and verbal learning with early childhood stroke (29 days to <6 years), showing significantly worse cognitive outcome compared to neonatal or late childhood stroke (p < 0.05, false discovery rate-corrected).
Discussion:
Age at stroke is an important factor for poststroke recovery and modulates long-term cognitive outcome irrespective of lesion size and lesion location. Children after early childhood stroke are at particular risk for long-term alterations in cognitive functions.
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