Cognitive Impairment Remains Prevalent First Year After Stroke in Young Adults

Cognitive impairment remains prevalent 1-year poststroke among young adults, according to study findings published in the Journal of Neurology, Neurosurgery and Psychiatry. 

There is a lack of evidence surrounding the incidence and risk factors associated with cognitive recovery or decline after stroke in young patients aged 18 to 50. Researchers conducted a study to assess the trajectory of cognition during the first year poststroke in a population of young stroke patients. 

The current study is part of the Observational Dutch Young Symptomatic StrokE studY (ODYSSEY), a multicenter prospective cohort study. Study participants were individuals aged 18 to 49 who experienced their first cerebral ischemic stroke. Individuals with a history of stroke, retinal infarction, or cerebral venous sinus thrombosis were excluded from the analysis. 

Within 6 months after stroke, participants had a baseline neuropsychological assessment and a follow-up 1-year poststroke.   

The Mini-Mental State Examination (MMSE) assessed global cognitive functioning. The researchers used the​​ Reliable Change Index (RCI) to determine cognitive recovery, with an RCI greater than 1.96 indicating recovery and less than 1.96 indicating decline.

A total of 1322 patients experienced a stroke at a young age, with 598 completing the baseline assessment and 393 completing the final follow-up at 1 year. The median age of stroke onset was 44.3 years and 49.6% were women. Upon admission, the median National Institutes of Health Stroke Scale (NIHSS) score was 2.

Participants received their first cognitive assessment at a median time of 80 days from the index event.

Compared to baseline, the percentage of participants with cognitive impairment decreased at follow-up in the areas of episodic memory (19.1% vs 11.7%; P =.001), processing speed (27.6% vs 23.0%; P =.021) and language deficits (17.0% vs 9.1%; P <.001).

The greatest improvement in cognitive performance was found in the domains of episodic memory (21.9%), processing speed (16.6%), visuoconstruction (26.8%) and language deficits (17.6%). Less than 10% of patients improved in the other cognitive domains. 

A majority of patients did not display cognitive change based on RCI (98.7%). Based on RCI, the greatest improvement was observed in processing speed (7.2%) and visuoconstruction (18.1%); however, a similar proportion of participants showed cognitive deficits, with 8.2% experiencing a decline in processing speed and 11.5% in visuoconstruction.

Individuals with processing speed impairment at baseline who recovered tended to have larger lesion volume compared to those who did not recover (26.8 mL vs 10.1 mL; P =.006).

Patients with cognitive impairment in visuoconstruction during baseline who recovered tended to be younger than those who did not recover (median age, 40.2 years vs 44.6 years; P =.045).

Study limitations included the lack of data regarding patients who were unable or refused to participate, the wide range in time of baseline assessments, and the lack of information regarding other cognitive interventions. 

“These findings are relevant for young stroke patients, as they have to cope with these consequences for the rest of their lives. Predicting cognitive recovery for the individual patient remains difficult,” the researchers concluded.