Cognitive recovery in patients with post-stroke subjective cognitive complaints

So NO protocols written on how to recover your 5 lost years of brain cognition due to your stroke.  You're completely on your own to figure out your cognitive recovery.  Hope you have enough functioning brain cells for that project.

Cognitive recovery in patients with post-stroke subjective cognitive complaints

Shaozhen Ji¹, Hong Sun², Xianglan Jin¹, Baoxin Chen¹, Jing Zhou¹, Jiayi Zhao³, Xiao Liang⁴, Wei Shen⁴, Yunling Zhang^1,4* and Piu Chan^2*

• ¹Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
• ²Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
• ³Department of Neurology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
• ⁴Department of Neurology, China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China

Background and purpose: The objective cognitive trajectory in patients with post-stroke subjective cognitive complaints (SCC) over time remained unknown. We investigated cognitive outcomes in patients with SCC within 1 year after stroke, and determined factors associated with cognitive recovery.

Methods: This study included 599 patients with a clinical diagnosis of post-stroke SCC and evidence of cognitive deficits including Clinical Dementia Rating Scale (CDR) = 0.5, Montreal Cognitive Assessment (MoCA) score <26, and Mini–Mental State Examination score >17 (illiterate) or >20 (primary school) or >24 (junior school or above). Neuropsychological assessment was performed at baseline (2 weeks to 6 months after stroke) and 6-month follow-up visit. Cognitive recovery was operationalized as unimpaired cognition (MoCA score ≥26 and CDR = 0) after 6 months. Factors associated with recovery were defined through logistic regression analysis.

Results: After 6 months, 583 patients completed the follow-up with 80 (13.72%) presenting cognitive recovery, among which, 22 (9.48%) cases reported SCC within 2 weeks after stroke, six (10%) at 15–30 days, 13 (15.12%) at 31–60 days, 10 (16.13%) at 61–90 days, five (10.42%) at 91–120 days, nine (23.08%) at 121–150 days, and 15 (26.79%) at 151–180 days. Compared to those reported cognitive complaints at 151–180 days after stroke, patients with early post-stroke SCC had poorer cognitive recovery, which was only significant in individuals with high level of education. Male sex, higher baseline MoCA scores, coffee intake and thalamus lesions were independently associated with high chance of cognitive recovery.

Conclusions: Although post-stroke SCC contributes to persisting objective cognitive deficits, some patients presented cognitive recovery within 1 year after stroke. Patients with a high education level reporting SCC at earlier stage after stroke had poorer cognitive recovery. Male, higher baseline MoCA scores, coffee intake and thalamus lesions appear to independently predict cognitive recovery.(How much coffee? Regular or decaf?)

Introduction

Subjective cognitive complaints (SCC) are common after stroke with estimated prevalence varying from 28.6 to 92%, defined as whether survivors themselves report cognitive difficulties or problems and if so what these are and whether they are irritating and/or worrying for them (1, 2). Given that the presence of post-stroke SCC was observed significantly correlating with poor cognitive performances (3, 4), it contributes to recognition and diagnosis of post-stroke cognitive impairment (PSCI). However, evidences have shown that post-stroke SCC is inconsistently associated with objective cognitive performance (1, 5), which may be attributed to screening or assessment time of cognitive complaints, since many patients with cognitive disorders after stroke will show recovery over time (4, 6–9). Thus far, most of the studies depend on cross-sectional designs and as such provide limited information about objective cognitive trajectory in patients with post-stroke SCC over time (10). Whether patients with post-stroke SCC will show improvement in cognitive function is still unknown. Identifying patients with potential for cognitive recovery after stroke and predictors may enrich our understanding of the etiology of PSCI and guide diagnosis and individualized rehabilitation intervention.

In the present longitudinal study, we investigated cognitive outcomes in patients with evidence of objective cognitive disorders who reported SCC in the early phase (within 6 months) after stroke, and identified factors related to cognitive recovery. Taking into account the association between SCC and cognitive reserve (CR) (11, 12), we also identified the influence of education on cognitive recovery in patients with post-stroke SCC. Our results are based on the data for the “prospective multi-center cohort study of PSCI” (13).

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