Cognitive assessment in patients with acute stroke: Exploring early intervention for dementia

Early detection of cognitive impairment in patients with acute stroke could improve dementia treatment; however, such testing is uncommon. This study aimed to assess cognitive testing feasibility in patients with acute stroke and identify patient characteristics associated with testing ability.

291 patients with suspected acute stroke were admitted to our hospital between December 2016 and May 2017. Of these, 280 were diagnosed with stroke (median [interquartile range] age 73 [63-81] years; 70 % male; 11 % with prior cognitive decline) and included in the study. Patients able or unable to complete three cognitive function tests were classified as the testable or untestable group, respectively.

Among the 280 patients, 72 % completed all three cognitive tests a mean of 4 [3-5] days after onset. Significant differences were found between the testable and untestable groups, particularly in age (70 [61-80] vs. 77 [69-84], p < 0.0001), Informant Questionnaire on Cognitive Decline in the Elderly score (78 [78-83] vs. 84 [78-96], p = 0.012), and National Institutes of Health Stroke Scale (NIHSS) score at onset (3 [1-6] vs. 13 [4-18], p < 0.0001). Advanced age, a higher NIHSS score, and pre-stroke cognitive decline were independent risk factors for the inability to undergo testing.

Cognitive testing was feasible in 72 % of patients with acute stroke, particularly those who were younger, had normal pre-stroke cognitive function, and experienced mild strokes. Early cognitive assessment may enable timely dementia detection and treatment.