Poststroke Neurocognitive Disorder Prevalent in Acute Stroke

Poststroke neurocognitive disorder (NCD) occurs in the majority of patients affected by stroke with associated cerebral infarct or hemorrhage, according to a study published in Stroke. A shortened summary cognitive score consisting of action speed, executive function, and language may help diagnose poststroke NCD.

Using the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network standardized battery, investigators assessed patients who had a stroke (n=404) from the GRECOG-VASC (Groupe de Réflexion pour l’Évaluation Cognitive Vasculaire) cohort at 6 months following stroke for cognitive function. People who had a stroke included those with cerebral infarct (91.3%) or hemorrhage (18.7%). Data from those who had a stroke were compared with data from healthy controls (n=1003). Investigators also used the VASCOG (Vascular Behavioral and Cognitive Disorders) criteria to identify diagnoses of mild and major poststroke NCD.

The shortened summary cognitive score, which corresponded with the average of the most commonly impaired domains (ie, action speed [odds ratio (OR) 2.24; 95% CI, 1.85-2.71; P =.0001], executive function [OR 1.8; 95% CI, 1.44-2.25; P =.0001], and language [OR 1.33; 95% CI, 1.15-1.53; P =.0001]), demonstrated the most optimal criteria for cognitive impairment, primarily as a result of being associated with the highest corrected true-positive (43.5%) and false-positive rate of ≤5%. With the short summary score, the average prevalence of poststroke NCD was approximately 49.5% (95% CI, 44.6-54.4). The majority of NCD prevalence was attributed to mild NCD (39.1%; 95% CI, 34.4-43.9) for 79% of the total NCD vs dementia (10.4%; 95% CI, 7.4-13.4), which was potentially associated with Alzheimer disease in 21.4% of patients.

The examination of only outpatients taking a neuropsychological battery may reduce the generalizability of these findings across population-based data.

In conclusion, findings from this study indicate “that even in the era of dedicated stroke units, a large proportion of stroke survivors experience cognitive impairment.”

Reference

Barbay M, Taillia H, Nédélec-Ciceri C, et al. Prevalence of poststroke neurocognitive disorders using National Institute of Neurological Disorders and Stroke-Canadian Stroke Network, VASCOG criteria (vascular behavioral and cognitive disorders), and optimized criteria of cognitive deficit. Stroke. 2018;49:1141-1147.