Hidden dysfunctioning in subacute stroke
| Autor: | Sandra Trabucco-Miguel, Assia Jaillard, Marc Hommel, Jean François Lebas, Bernadette Naegele |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Sensitivity and Specificity Physical medicine and rehabilitation Cognition Medicine Humans Prospective Studies Stroke Episodic memory Aged Advanced and Specialized Nursing Intelligence Tests business.industry Working memory Cognitive disorder Neuropsychology Middle Aged Executive functions medicine.disease Cognitive test Logistic Models Case-Control Studies Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Stroke recovery Cognition Disorders |
| Zdroj: | Stroke. 40(7) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose— Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF. Methods— Patients with Mini-Mental State Examination scores ≥23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education- and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression. Results— Among 177 patients (mean age, 50.6 years), 91.5% failed in at least one cognitive domain. WM was the most impaired domain (87.6%) with executive functions (64.4%), episodic memory (64.4%), and instrumental functions (24.9%) being relatively preserved. CDF was associated with age, education, depression, neurological deficit, and leukoaraiosis in bivariate analysis. Using logistic regression, WM tests and age predicted CDF (Modified Paced Auditorial Serial Addition Test: OR=0.96 CI=0.93 to 0.98; Owen-spatial-WM: OR=1.07 CI=1.02 to 1.12; age: OR=0.96 CI=0.93 to 0.98). Conclusion— CDF appears to be almost constant, although underestimated, in subacute stroke. WM could reflect some hidden dysfunctioning, which may interfere with rehabilitation and return to work. Clinical routine may include WM tests in young patients with mild stroke. |
| Databáze: | OpenAIRE |
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