Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke

ABSTRACT

This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch’s t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.

KEYWORDS:

• Neuropsychology
• pediatric
• stroke
• ischemic
• hemorrhagic

Acknowledgments

The primary author (C.C.) wishes to thank the Social Sciences and Humanities Research Council of Canada (SSHRC) and the Canadian Psychological Association (CPA) for their support of this research. The second author (S.J.F.) is supported by the Canadian Institutes for Health Research (CIHR), funding reference number: 181532. We also wish to thank the participants and their families, who generously donated their time to participate in our study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary data

Supplemental data for this article can be accessed at https://doi.org/10.1080/09297049.2023.2213461

Notes

¹ A small-medium infarct involved less than 2/3 of total volume of one lobe or major subcortical structure or less than 1/2 of the volume of 2+ lobes or subcortical structures, while a large lesion involved greater than 2/3 of the volume of one lobe or major subcortical structure or greater than 1/2 of the volume of 2+ lobes or subcortical structures.

² Intraparenchymal hemorrhage volume and total brain volume were calculated via the ABC/2 (aka ABC/XYZ) method and the hematoma was classified following standard guidelines.

Additional information

Funding

The work was supported by the Canadian Psychological Association Social Sciences and Humanities Research Council of Canada; Canadian Institutes of Health Research [181532].