Neuropsychological and neuroimaging markers in prediction of cognitive impairment after ischemic stroke: a prospective follow-up study

Figures & data

Table 1 Baseline characteristics of patients and normal controls (NCs)

Baseline	NCs N=25	Poststroke patients N=85	Poststroke patients (NL) (IST >28) N=46	Poststroke patients (at risk) (IST ≤28) N=39
Age, years	64.1 (5.3)	65.6 (5.6)	64.5 (6.0)	66.6 (5.4)
Sex (male/female)	18/7	67/18	34/12	33/6
Education, years	11.7 (2.2)	11.3 (2.2)	11.5 (2.4)	11.0 (1.8)
MMSE	27.9 (1.4)	26.6 (2.3)***	27.3 (1.4)**	25.7 (2.7)
Diabetes (%)	4	28*	30	26
Hypertension (%)	76	86	85	87
NIHSS	0	4.6 (0.9)	4.6 (0.7)	4.7 (0.6)

Notes: Means are given with standard deviations in parentheses. A comparison (t-test) with control group was performed.

* P<0.05;

** P<0.01;

*** P<0.001. Insignificant results are with P>0.1.

Abbreviations: IST, Isaacs Set Test; MMSE, mini–mental state examination; NCs, normal controls; NIHSS, National Institutes of Health Stroke Scale; NL, normal limits.

Table 2 Neuropsychological performance in NCs and patients at 5th day after stroke onset (baseline) and follow-up assessments

	NC	Stroke patients 5th day	Stroke patients 1st month	Stroke patients 6th month	Stroke patients 12th month
MMSE	27.9 (1.3)	26.6 (2.3)**	26.3 (2.8)**	26.9 (2.2)*	26.4 (2.8)*
• Orientation	10.0 (0.0)	9.7 (0.6)*	9.6 (1.0)*	9.7 (0.7)*	9.6 (0.8)**
• Memory	5.5 (0.7)	5.4 (0.8)	5.3 (0.9)	5.4 (0.8)	5.3 (0.9)
• Attention	4.4 (0.7)	4.1 (1.1)	4.0 (1.1)	4.2 (1.0)	4.0 (1.3)
• Language	7.1 (0.7)	6.6 (0.7)**	6.7 (0.7)*	6.9 (0.6)	6.8 (0.8)
• Praxis	0.9 (0.3)	0.8 (0.4)	0.7 (0.5)	0.8 (0.4)	0.7 (0.4)
IST	34.8 (3.1)	28.4 (5.9)***	28.5 (6.3)***	30.0 (5.7)***	29.4 (5.7)***
IADL (4 items)	0 (0)	0.2 (0.6)	0.6 (1.0)**	0.5 (0.9)**	0.7 (1.6)*
CERAD episodic memory
–Immediate recall
• I trial	4.0 (1.5)	3.0 (1.4)**	4.3 (1.5)	4.7 (1.7)~	4.6 (1.7)~
• II trial	6.6 (1.1)	5.1 (1.6)***	5.8 (1.6)*	6.0 (1.7)	6.1 (1.7)
• III trial	7.3 (1.1)	6.0 (1.6)***	6.3 (1.9)***	6.3 (1.6)***	6.6 (1.6)***
–Delayed recall	5.3 (1.6)	3.3 (2.2)***	4.4 (2.6)	4.7 (2.2)	5.2 (2.4)
–Recognition	18.7 (1.3)	16.6 (2.8)***	17.9 (2.3)~	18.0 (2.3)	18.3 (2.0)
TMT-A	57.3 (13.6)	98 (46)***	86 (41)***	80 (38)**	83 (44)**
TMT-B	111.7 (27.3)	209 (73)***	188 (81)***	174 (74)***	173 (77)***
BNT	14.6 (0.6)	14.1 (1.1)~	14.5 (0.9)	14.6 (0.7)	14.6 (0.7)
Figure copying	10.5 (0.7)	10.2 (1.1)	10.3 (1.1)	10.2 (1.1)	10.2 (1.0)
GDS	3.4 (2.0)	4.2 (3.2)	4.2 (3.1)	3.8 (3.4)	3.8 (3.5)

Notes: Means are given with standard deviations in parentheses. A comparison (t-test or chi-square) with control group was performed for each test in follow-up examinations.

~ P<0.09;

* P<0.05;

** P<0.01;

*** P<0.001. Insignificant results are with P>0.1.

Abbreviations: BNT, Boston Naming Test; CERAD, Consortium to Establish a Registry for Alzheimer’s Disease; GDS, Geriatric Depression Scale; IADL, Instrumental Activities of Daily Living; IST, Isaacs Set Test; MMSE, mini–mental state examination; NC, normal control; TMT-A, Trail Making Test, part A; TMT-B, Trail Making Test, part B.

Table 3 Neuropsychological assessments in patients’ subgroups divided by IST criterion

Fifth day	Stroke patients (at risk) IST ≤28	Stroke patients (NL) IST >28
MMSE	25.7 (2.7)	27.3 (1.5)**
• Orientation	9.5 (0.7)	9.8 (0.4)*
• Memory	5.2 (0.9)	5.5 (0.6)*
• Attention	3.8 (1.4)	4.3 (0.8)*
• Language	6.5 (0.7)	6.8 (0.6)*
• Praxis	0.7 (0.4)	0.8 (0.4)
IST	23.5 (4.6)	32.5 (2.7)***
IADL (4 items)	0.31 (0.9)	0.02 (0.1)*
CERAD episodic memory
–Immediate recall
• I trial	2.6 (1.4)	3.4 (1.3)**
• II trial	4.4 (1.4)	5.7 (1.6)***
• III trial	5.2 (1.6)	6.6 (1.3)***
–Delayed recall	2.1 (1.9)	4.3 (2.0)***
–Recognition	15.3 (3.0)	17.7 (2.2)***
TMT-A	116 (43)	84 (44)**
TMT-B	248 (62)	176 (66)***
BNT	13.8 (1.2)	14.4 (1.0)*
Figure copying	10.0 (1.2)	10.4 (1.0)
GDS	5.1 (3.4)	3.4 (2.9)*

Notes: Means are given with standard deviations in parentheses separately for patients divided by IST criterion. t-test compares scores between two groups of IST-divided patients.

* P<0.05;

** P<0.01;

*** P<0.001.

Abbreviations: BNT, Boston Naming Test; CERAD, Consortium to Establish a Registry for Alzheimer’s Disease; GDS, Geriatric Depression Scale; IADL, Instrumental Activities of Daily Living; IST, Isaacs Set Test; MMSE, mini–mental state examination; NL, normal limits; TMT-A, Trail Making Test, part A; TMT-B, Trail Making Test, part B.

Table 4 Means of neuropsychological measures ±95% confidence intervals (in parentheses) per condition

IST groups	Measures in time
	5th day	1st month	6th month	12th month
	IST
At risk	23.5 (1.5)	25.1 (2.1)	26.7 (1.8)	26.3 (2.1)
NL	32.6 (0.8)	31.4 (1.3)	32.3 (1.5)	31.5 (1.5)
	MMSE
At risk	25.3 (1.1)	25.7 (0.9)	26.2 (1.0)	25.1 (1.2)
NL	27.1 (0.6)	27.3 (0.4)	27.4 (0.5)	27.3 (0.7)
	Recognition
At risk	15.3 (1.0)	16.9 (0.8)	17.3 (0.8)	17.3 (0.9)
NL	17.7 (0.7)	18.7 (0.5)	18.6 (0.6)	18.9 (0.4)
	Delayed recall
At risk	2.1 (0.6)	3.4 (0.8)	3.9 (0.8)	4.1 (0.9)
NL	4.3 (0.6)	5.2 (0.8)	5.3 (0.6)	6.0 (0.7)
	IADL
At risk	0.3 (0.3)	0.9 (0.4)	0.8 (0.4)	1.4 (0.8)
NL	0.0 (0.0)	0.4 (0.2)	0.3 (0.2)	0.3 (0.2)

Notes: NL group: the patients with IST score within the NL (IST >28). At risk group: those at risk of cognitive decline with IST score ≤28.

Abbreviations: IADL, Instrumental Activities of Daily Living; IST, Isaacs Set Test; MMSE, mini–mental state examination; NL, normal limits.

Table 5 Means of neuroimaging measures ±95% confidence intervals (in parentheses) per IST group

IST groups	Hippocampal atrophy	Basal ganglia lesions	PVC
At risk	1.2 (0.4)	8.8 (1.7)	2.8 (0.4)
NL	0.6 (0.2)	6.4 (1.2)	2.3 (0.4)

Notes: NL group: the patients with IST score within the NL (IST >28). At risk group: those at risk of cognitive decline with IST score ≤28.

Abbreviations: IST, Isaacs Set Test; NL, normal limits; PVC, periventricular change.

Table 6 Simultaneous multiple regression analyses on neuropsychological measures (12th month) with neuroimaging predictors

Neuropsychological measures at 12th month	Hippocampal atrophy			Basal ganglia lesions			PVCs
	β	t	P-value	β	t	P-value	β	t	P-value
MMSE	−0.3	−2.2	0.03	−0.2	−1.9	0.07	0.0	0.1	0.94
MMSE (orientation)	−0.2	−1.6	0.1	−0.2	−1.3	0.2	−0.0	−0.3	0.8
MMSE (attention)	−0.3	−2.4	0.01	−0.1	−1.2	0.2	−0.0	−0.0	0.9
MMSE (memory)	−0.3	−2.4	0.02	−0.1	−0.5	0.6	0.1	0.8	0.4
MMSE (language)	0.1	1.1	0.3	−0.3	−2.4	0.02	−0.1	−0.8	0.4
MMSE (praxis)	−0.1	−1.0	0.3	−0.1	−0.6	0.6	0.1	0.7	0.5
IST	−0.4	−3.3	0.001	−0.2	−1.3	0.19	−0.1	−1.0	0.31
IADL	0.3	2.5	0.01	0.0	0.2	0.83	−0.1	−0.4	0.7
Delayed recall	−0.4	−3.8	0.00	0.0	0.3	0.7	−0.1	0.4	0.7
Recognition	−0.3	−2.9	0.005	−0.0	−0.3	0.7	−0.2	−1.2	0.2
TMT-B	0.3	2.7	0.008	0.3	2.5	0.01	0.2	1.6	0.1
TMT-A	0.3	2.8	0.007	0.3	2.7	0.01	0.1	1.1	0.3

Note: For each predictor, the β, t statistic, and P-value are reported.

Abbreviations: β, beta weight; IADL, Instrumental Activities of Daily Living; IST, Isaacs Set Test; MMSE, mini–mental state examination; PVCs, periventricular changes; TMT-A, Trail Making Test, part A; TMT-B, Trail Making Test, part B.