Find in Library
Search millions of books, articles, and more
Indexed Open Access Databases
Characterization and individual-level prediction of cognitive state in the first year after 'mild' stroke.
oleh: Juan Pablo Saa, Tamara Tse, Gerald Choon-Huat Koh, Philip Yap, Carolyn M Baum, David E Uribe-Rivera, Saras M Windecker, Henry Ma, Stephen M Davis, Geoffrey A Donnan, Leeanne M Carey
| Format: | Article |
|---|---|
| Diterbitkan: | Public Library of Science (PLoS) 2024-01-01 |
Deskripsi
<h4>Background</h4>Mild stroke affects more than half the stroke population, yet there is limited evidence characterizing cognition over time in this population, especially with predictive approaches applicable at the individual-level. We aimed to identify patterns of recovery and the best combination of demographic, clinical, and lifestyle factors predicting individual-level cognitive state at 3- and 12-months after mild stroke.<h4>Methods</h4>In this prospective cohort study, the Montreal Cognitive Assessment (MoCA) was administered at 3-7 days, 3- and 12-months post-stroke. Raw changes in MoCA and impairment rates (defined as MoCA<24 points) were compared between assessment time-points. Trajectory clusters were identified using variations of ≥1 point in MoCA scores. To further compare clusters, additional assessments administered at 3- and 12-months were included. Gamma and Quantile mixed-effects regression were used to predict individual MoCA scores over time, using baseline clinical and demographic variables. Model predictions were fitted for each stroke survivor and evaluated using model cross-validation to identify the overall best predictors of cognitive recovery.<h4>Results</h4>Participants' (n = 119) MoCA scores improved from baseline to 3-months (p<0.001); and decreased from 3- to 12-months post-stroke (p = 0.010). Cognitive impairment rates decreased significantly from baseline to 3-months (p<0.001), but not between 3- and 12-months (p = 0.168). Nine distinct trajectory clusters were identified. Clinical characteristics between clusters at each time-point varied in cognitive outcomes but not in clinical and/or activity participation outcomes. Cognitive performance at 3- and 12-months was best predicted by younger age, higher physical activity levels, and left-hemisphere lesion side.<h4>Conclusion</h4>More than half of mild-stroke survivors are at risk of cognitive decline one year after stroke, even when preceded by a significantly improving pattern in the first 3-months of recovery. Physical activity was the only modifiable factor independently associated with cognitive recovery. Individual-level prediction methods may inform the timing and personalized application of future interventions to maximize cognitive recovery post-stroke.