Oh god, more worthless shitworthy research. Describes a problem, offers NO SOLUTION. Cognitive impairment has been known for centuries, we don't need more research dissecting it another way. SOLUTIONS ONLY PEOPLE!
And you use the crutch of further research needed to explain why you did nothing useful.
Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study
Stina Aam1,2*, 
Marte Stine Einstad1, 
Ragnhild Munthe-Kaas3,4, 
Stian Lydersen5, Hege Ihle-Hansen3,4,6, Anne-Brita Knapskog6, Hanne Ellekjær1,7, Yngve Seljeseth8 and 
Ingvild Saltvedt1,2- 1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- 2Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- 3Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
- 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- 5Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- 6Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- 7Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- 8Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
Background: Post-stroke cognitive
impairment (PSCI) is common, but evidence of cognitive symptom profiles,
course over time, and pathogenesis is scarce. We investigated the
significance of time and etiologic stroke subtype for the probability of
PSCI, severity, and cognitive profile.
Methods: Stroke survivors (n =
617) underwent cognitive assessments of attention, executive function,
memory, language, perceptual-motor function, and the Montreal Cognitive
Assessment (MoCA) after 3 and/or 18 months. PSCI was classified
according to DSM-5 criteria. Stroke severity was assessed with the
National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was
categorized as intracerebral hemorrhage (ICH), large artery disease
(LAD), cardioembolic stroke (CE), small vessel disease (SVD), or
un-/other determined strokes (UD). Mixed-effects logistic or linear
regression was applied with PSCI, MoCA, and z-scores of the cognitive
domains as dependent variables. Independent variables were time as well
as stroke subtype, time, and interaction between these. The analyses
were adjusted for age, education, and sex. The effects of time and
stroke subtype were analyzed by likelihood ratio tests (LR).
Results: Mean age was 72 years (SD 12),
42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8).
Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51–0.66)
and 0.51 (0.52–0.60), respectively and remained constant over time.
Global measures and most cognitive domains were assessed as impaired for
the entire stroke population and for most stroke subtypes. Executive
function and language improved for the entire stroke population (LR) =
9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively).
After dividing the sample according to stroke subtypes, language
improved for ICH patients (LR = 18.02, p = 0.003). No significant
differences were found in the severity of impairment between stroke
subtypes except for attention, which was impaired for LAD and CE in
contrast to no impairment for SVD (LR = 56.58, p < 0.001).
Conclusions: In this study including
mainly minor strokes, PSCI is common for all subtypes, both early and
long-term after stroke, while executive function and language improve
over time. The findings might contribute to personalizing follow-up and
offer new insights into underlying mechanisms. Further research is
needed on underlying mechanisms, PSCI prevention and treatment, and
relevance for rehabilitation.
Introduction
Stroke is one of two leading causes of disability-adjusted life-years worldwide (1),
and post-stroke cognitive impairment (PSCI) has been shown to be common
among stroke survivors. Recent reviews and meta-analyses identified a
pooled prevalence of PSCI of 53.4% and mild and major PSCI of 36.4–38
and 16% respectively, measured within 1.5 years post-stroke (2, 3).
Previous studies have reported conflicting results
regarding the prognosis for patients suffering PSCI; these have
indicated deterioration, no progression, and even improvement in
cognition over time for subgroups (4–11).
Several cognitive domains are affected in PSCI; of these, impairment in
attention and executive function seem to be the most prevalent and
severe shortly after and a long time after suffering a stroke (12–16).
A recent study on PSCI a short time after a stroke showed a high
prevalence of impairment in global cognition and in the five most
commonly assessed domains: attention, memory, language, perceptual-motor
function, and executive function (17).
The underlying pathological mechanisms for suffering a
stroke are heterogeneous, and severity and localization of the stroke
are important for PSCI (6, 17, 18).
About 10–20% of strokes are hemorrhagic; the rest are ischemic and
typically related to large artery disease (LAD), cardioembolic stroke
(CE), or small vessel disease (SVD), often labeled lacunar infarction,
with about 25% in each category (19–21). LAD and CE strokes are often cortical strokes of large volume, while SVD strokes are subcortical and of small volume (22).
Cognitive impairment has been shown to be less common in the early
post-stroke period in SVD compared to other stroke subtypes, but SVD is
associated with cognitive decline long after a stroke (16, 17, 23, 24).
However, in their review and meta-analyses, Makin et al. found similar
proportions to have PSCI in lacunar vs. non-lacunar stroke [OR 0.75 (95%
CI 0.47–1.20)] (25, 26). ICH has been reported to be more strongly associated with dementia than ischemic stroke (6),
and impairments in processing speed, executive function, episodic
memory, language, and visuo-spatial abilities have been found to be most
prevalent (19, 21, 27).
There remains a need for additional knowledge about the
course of PSCI and the impact of stroke subtypes on PSCI. Therefore, the
aim of this study was to investigate whether time and etiological
stroke subtype impact the probability for PSCI and its severity and
cognitive symptom profile three and 18 months post-stroke.
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