Predictors of cognitive and emotional symptoms 12 months after first-ever mild stroke

Figures & data

Table 1. Cognitive domains, emotional symptoms and used tests.

Cognitive domains, emotional symptoms	Used tests
Global cognitive functioning	MMSE NR2
Visuospatial function	Clock Drawing test; ROCF, copy
Psychomotor speed	TMT A; TMT B; COWA Verbal Fluency Test
Attention	TMT A; TMT B; COWA Verbal Fluency Test
Executive functioning	Clock Drawing test; TMT B; COWA Verbal Fluency test; ROCF, copy and delayed recall
Visual memory	ROCF, delayed recall
Language ability	COWA Verbal Fluency Test
Verbal memory and learning ability	CVLT II, total learning; CVLT II, short delay, free recall; CVLT II, long delay, free recall
Anxiety and depression	HADS
Fatigue	FSS
Apathy	AES-S
Emotional Instability	PLACS

MMSE NR2, Norwegian Revised version 2 of the Mini-Mental State Examination; ROCF, Rey-Osterrieth Complex Figure; TMT, Trail Making Test; COWA, Controlled Oral Word Association; CVLT II, California Verbal Learning Test-II; HADS, Hospital Anxiety and Depression Scale; FSS, Fatigue Severity Scale; AES-S, Apathy Evaluation Scale-Self Report; PLACS, Pathological Laughter And Crying Scale

Figure 1. Flow chart of the study participants.

Table 2. Baseline characteristics. Mean ± standard deviation (SD) for continuous data, n (%) for binary data, unless otherwise specified.

Variables	Total sample N = 127	Male n = 98	Female n = 29
Demographics
Male, n	98 (77)
Age, mean ± SD (range)	55.7 ± 11.3 (30-70)	56.5 ± 10.8 (31-70)	53.4 ± 12.9 (30-69)
Living alone at stroke onset	34 (27)	26 (27)	8 (28)
Not working at stroke onset	38 (30)	26 (27)	12 (41)
Education in years/all patients, mean ± SD	15.3 ± 3.6	15.5 ± 3.5	14.5 ± 3.9
Education in years/not working patients, mean ± SD	14.3 ± 3.9	15.0 ± 4.0	12.9 ± 3.4
Comorbidity
Hypertension	59 (47)	50 (51)	9 (31)
Hyperlipidaemia	90 (71)	76 (78)	14 (48)
APOE-ϵ4 allele (missing cases 7)	42 (35)	33 (36)	9 (32)
Coronary disease	14 (11)	14 (14)	0 (0)
Atrial fibrillation	11 (9)	10 (10)	1 (3)
Cigarette smoking	33 (26)	27 (27)	6 (20)
Diabetes mellitus	15 (12)	14 (14)	1 (3)
BMI, mean ± SD	26.9 ± 4.4	27.4 ± 4.4	25.4 ± 4.1
Stroke subtype
Ischemic	119 (94)	92 (94)	27 (93)
Haemorrhagic	8 (6)	6 (6)	2 (7)
TOAST classification
Large vessel disease	20 (17)	16 (18)	4 (15)
Cardio embolic disease	32 (27)	26 (28)	6 (22)
Small vessel disease	33 (28)	28 (30)	5 (19)
Stroke of unknown/other aetiology	34 (28)	22 (24)	12 (41)
OCSP classification at admission
Anterior circulation infarct (ACI)	57 (48)	42 (45)	15 (56)
Lacunar infarct (LACI)	27 (23)	21 (23)	6 (22)
Posterior circulation infarct (POCI)	35 (29)	29 (32)	6 (22)
Stroke localization, MRI/CT-findings
Right hemisphere	46 (36)	38 (39)	8 (28)
Left hemisphere	36 (28)	24 (24)	12 (41)
Cerebellum/brainstem	20 (16)	14 (14)	6 (21)
Multiple brain regions	17 (13)	15 (15)	2 (7)
No visible acute lesions	8 (6)	7 (7)	1 (3)
Assessments
NIHSS at discharge, median (range)	0 (0-3)	0 (0-3)	0 (0-3)
mRS at discharge, median (range)	1 (0-4)	1 (0-4)	1 (0-4)
mRS 0–1 at discharge	98 (77)	76 (78)	22 (76)
BI at discharge, mean ± SD (range)	19.7 ± 1.1 (11-20)	19.7 ± 1.1 (11-20)	19.7 ± 1.3 (13-20)
BI at discharge, median (range)	20 (11-20)	20 (11-20)	20 (13-20)
Cognitive assessments
IQCODE, mean ± SD	3.02 ± 0.07	3.03 ± 0.08	3.01 ± 0.03

Hyperlipidaemia: total cholesterol > 5 mmol/l or LDL > 3 mmol/l; APOE-ϵ4: Apolipoprotein E-epsilon 4; Coronary disease: myocardial infarction, angina pectoris; Cigarette smoking: ≥ 1 cigarette/day; BMI, body mass index; TOAST, Trial of Org 10172 in Acute Stroke Treatment; OCSP, Oxfordshire Community Stroke Project Classification; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale; BI, Barthel index; IQCODE, Informant Questionnaire on Cognitive Decline in the Elderly

Table 3. Cognitive and emotional functioning 12 months after stroke. Mean ± standard deviation (SD) for continuous data, n (%) for categorical data, unless otherwise specified.

12 months follow up	Total sample N = 117	Male n = 90	Female n = 27
Variables
Assessments
mRS, median (range)	1 (0–3)	1 (0–3)	1 (0–3)
mRS 0–1	88 (75)	72 (80)	16 (59)
mRS 2	26 (22)	17 (19)	9 (33)
mRS 3	3 (3)	1 (1)	2 (8)
Barthel Index (range)	19.9 ± 0.1 (19–20)	20.0 ± 0.0 (20–20)	19.9 ± 0.2 (19–20)
Identified impairments
No detectable impairments	21 (18)	16 (18)	5 (18)
Any cognitive impairment	78 (67)	63 (70)	15 (56)
Any emotional impairment	50 (43)	34 (38)	16 (59)
Combined cognitive and emotional impairments	32 (28)	23 (26)	9 (33)
Cognitive assessments
MMSE-NR2 score < 27/30	4 (3)	2 (2)	2 (8)
Clock drawing score <4/5	5 (4)	3 (3)	2 (8)
TMT A, time > 60 sec	1 (1)	0 (0)	1 (4)
TMT B, time >120 sec	12 (10)	10 (11)	2 (8)
COWA, verbal fluency ≤ −1 SD	46 (40)	38 (43)	8 (30)
ROCF, copy ≤−1 SD	11 (9)	9 (10)	2 (8)
ROCF, delayed recall ≤−1 SD	34 (29)	28 (31)	6 (22)
CVLT-II, total learning ≤−1 SD	6 (5)	3 (3)	3 (11)
CVLT-II, short delay free recall ≤ −1SD	15 (13)	10 (11)	5 (18)
CVLT-II, long delay free recall ≤ −1SD	9 (8)	5 (5)	4 (15)
Emotional assessments
HADS-Anxiety Scale, >7 points	18 (15)	10 (11)	8 (30)
HADS-Depression Scale, >7 points	15 (13)	9 (10)	6 (22)
HADS-Total, >14 points	15 (13)	7 (8)	8 (30)
FSS, ≥ 4 points	38 (33)	23 (26)	15 (56)
AES-S, ≥ 34 points	29 (25)	21 (23)	8 (30)
PLACS, ≥ 13 points	4 (3)	1 (1)	3 (11)

mRS, modified Rankin Scale; MMSE-NR2, Norwegian Revised version 2 of the Mini-Mental State Examination; TMT A, Trail Making Test A; TMT B, Trail Making Test B; COWA, Controlled Oral Word Association; ROCF, Rey-Osterrieth Complex Figure; CVLT II, California Verbal Learning Test-II; HADS, Hospital Anxiety and Depression Scale; FSS, Fatigue Severity Scale; AES-S, Apathy Evaluation Scale-Self Report; PLACS, Pathological Laughter And Crying Scale

Table 4. Predictors of cognitive impairments 12 months after mild stroke.

	Unadjusted		Adjusted
Variable	OR (95% CI)	p	OR (95% CI)	p
Age at baseline	1.00 (0.97–1.04)	0.95	0.95 (0.91–1.00)	0.05
Female gender	0.54 (0.22–1.29)	0.17	0.52 (0.18–1.51)	0.23
Marital state (not living alone)	0.66 (0.26–1.69)	0.37
Not working at admission	2.05 (0.83–5.08)	0.12	6.14 (1.69–22.26)	0.006
Education	0.98 (0.88–1.09)	0.74
BMI at admission	1.10 (0.99–1.21)	0.07	1.09 (0.98–1.24)	0.12
Hyperlipidaemia	0.64 (0.26–1.54)	0.32
Diabetes	3.36 (0.71–15.85)	0.13	4.91 (0.84–28.70)	0.08
Hypertension	1.11 (0.51–2.41)	0.79
Myocardial infarction	3.75 (0.44–33.59)	0.23
Atrial fibrillation	0.73 (0.19–2.75)	0.64
Presence of any APOE-ϵ4 allele	1.04 (0.46–2.37)	0.92
Intracerebral hemorrhage	1.00 (0.17–5.71)	1.00
Treatment with thrombolysis	1.27 (0.48–3.39)	0.63
Stroke location (no infarcts at MRI/CT)	1.00 (0.17–5.71)	1.00
Stroke location (right hemisphere)	0.90 (0.41–1.98)	0.79
Stroke location (left hemisphere)	0.54 (0.23–1.24)	0.15	0.71 (0.27–1.86)	0.48
Stroke location (cerebellum/brainstem)	0.91 (0.33–2.51)	0.86
Stroke location (multiple infarctions)	9.05 (1.15–71.26)	0.04	12.88 (1.49–111.13)	0.02
TOAST (large vessel disease)	1.10 (0.38–3.18)	0.86
TOAST (cardioembolic)	0.82 (0.34–1.96)	0.65
TOAST (small vessel disease)	1.63 (0.65–4.12)	0.30
TOAST (underdetermined/other etiology)	0.72 (0.30–1.71)	0.46
OCSP (ACI)	0.90 (0.41–1.98)	0.79
OSCP (LACI)	0.86 (0.34–2.18)	0.75
OCSP (POCI)	1.30 (0.54–3.11)	0.56
NIHSS at discharge	1.32 (0.84–2.07)	0.24
Barthel Score at discharge	1.02 (0.74–1.41)	0.91
mRS >1 at discharge	2.51 (0.86–7-26)	0.09	2.43 (0.75–7.87)	0.14

BMI, body mass index; APOE-ϵ4: Apolipoprotein E-epsilon 4; MRI: magnetic resonance imaging; CT: computed tomography; TOAST, Trial of Org 10172 in Acute Stroke Treatment; OCSP, Oxfordshire Community Stroke Project Classification; ACI: anterior circulation infarct; LACI: lacunar infarct; POCI: posterior circulation infarct; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale

Table 5. Predictors of emotional impairments 12 months after mild stroke.

	Unadjusted		Adjusted*
Variable	OR (95% CI)	p	OR (95% CI)	p
Age at baseline	0.97 (0.94–1.01)	0.12	0.98 (0.94–1.02)	0.26
Female gender	2.40 (1.00–5.76)	0.05	2.16 (0.84–5.56)	0.11
Marital state (not living alone)	1.16 (0.5–2.71)	0.73
Not working at admission	1.01 (0.45–2.24)	0.99
Education	0.98 (0.87–1.09)	0.71
BMI at admission	0.96 (0.90–1.07)	0.72
Hyperlipidaemia	0.78 (0.35–1.74)	0.55
Diabetes	1.94 (0.63–5.99)	0.25
Hypertension	0.69 (0.33–1.44)	0.32
Myocardial infarction	0.42 (0.08–2.19)	0.31
Atrial fibrillation	0.88 (0.24–3.32)	0.86
APOE (allele 4)	0.76 (0.34–1.67)	0.49
Intracerebral hemorrhage	0.66 (0.12–3.73)	0.64
Treatment with thrombolysis	0.76 (0.30–1.91)	0.56
Stroke location (no infarcts at MR/CT)	1.36 (0.26–7.05)	0.71
Stroke location (right hemisphere)	0.81 (0.38–1.74)	0.59
Stroke location (left hemisphere)	0.89 (0.39–2.03)	0.78
Stroke location (cerebellum/brainstem)	1.43 (0.54–3.74)	0.47
Stroke location (multiple infarctions)	1.05 (0.36–3.04)	0.93
TOAST (large vessel disease)	1.22 (0.45–3.30)	0.69
TOAST (cardioembolic)	0.83 (0.36–1.95)	0.67
TOAST (small vessel disease)	0.93 (0.40–2.15)	0.86
TOAST (underdetermined/other etiology)	1.11 (0.48–2.56)	0.80
OCSP (ACI)	1.08 (0.51–2.29)	0.85
OCSP (LACI)	0.54 (0.21–1.39)	0.20	0.50 (0.18–1-39)	0.19
OCSP (POCI)	1.48 (0.66–3.34)	0.34
NIHSS at discharge	1.57 (1.04–2.36)	0.03	1.57 (0.93–2.66)	0.09
Barthel score at discharge	0.70 (0.43–1.14)	0.15	0.83 (0.45–1.55)	0.57
mRS >1 at discharge	1.78 (0.74–4.29)	0.20	1.36 (0.42–4.44)	0.61

BMI, body mass index; APOE-ϵ4: Apolipoprotein E-epsilon 4; MRI: magnetic resonance imaging; CT: computed tomography; TOAST, Trial of Org 10172 in Acute Stroke Treatment; OCSP, Oxfordshire Community Stroke Project Classification; ACI: anterior circulation infarct; LACI: lacunar infarct; POCI: posterior circulation infarct; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale.