Cognitive impairment in lacunar strokes: The secondary prevention of small subcortical strokes (SPS3) trial
Annals of Neurology , 08/20/2012
Jacova C et al. – In this large, well characterized cohort of lacunar stroke patients, Mild Cognitive Impairment (MCI) was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.Methods
- All English-speaking participants in the SPS3 trial (NCT: 00059306) underwent neuropsychological testing at baseline.
- Raw scores were converted to z-scores using published norms.
- Those with impairment (z<-1.5) in memory and/or non-memory domains were classified as having Mild Cognitive Impairment (MCI).
- Among the 1636 participants, average z scores on all tests were below zero with the largest deficits seen on tests of episodic memory (range of means -0.65 to -0.92), verbal fluency (mean -0.89), and motor dexterity (mean -2.5).
- Forty-seven percent were classified as having MCI: 36% amnestic, 37% amnestic multidomain, 28% non-amnestic.
- Of those with Rankin score 0-1 and Barthel score=100, 41% had MCI.
- Younger age [odds ratio (OR) per 10-yr increase=0.87], male sex (OR 1.3), less education (OR 0.13-0.66 compared to 0-4 yrs education), post-stroke disability (OR 1.4), and impaired activities of daily living (OR 1.8) were independently associated with MCI.