Cognitive Impairment Vulnerability and Mortality Post Ischemic.pdf (280.73 kB)

Cognitive Impairment, Vulnerability, and Mortality Post Ischemic Stroke: A Five-Year Follow-Up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Cohort

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posted on 22.11.2019, 15:33 by Eva Gaynor, Daniela Rohde, Margaret Large, Lisa Mellon, Patricia Hall, Linda Brewer, Orla Conway, Anne Hickey, Kathleen Bennett, Eamon Dolan, Elizabeth Callaly, David Williams

Background

The aim of this study was to examine predictors of mortality in patients 5 years after ischemic stroke, focusing on cognitive impairment, vulnerability, and vascular risk factors assessed at 6 months post stroke.

Materials and Methods

Patients from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort were followed up 5 years post ischemic stroke. Vascular risk factors, cognitive impairment, and vulnerability were assessed at 6 months post stroke. Cognitive impairment was assessed using a cutoff score lower than 26 on the Montreal Cognitive Assessment (MoCA). Vulnerability was defined as a score of 3 or higher on the Vulnerable Elders Scale (VES). Mortality and date of death were ascertained using hospital records, death notifications, and contact with general practitioners. Predictors of mortality were explored using multivariate Cox proportional hazards models. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.

Results

Sixty-three of 256 patients (24.6%) assessed at 6 months post stroke had died within 5 years. Cognitive impairment (HR [95% CI]: 2.19 [1.42-3.39]), vulnerability (HR [95% CI]: 5.23 [2.92-9.36]), atrial fibrillation (AF) (HR [95% CI]: 2.31 [1.80-2.96]), and dyslipidemia (HR [95% CI]: 1.90 [1.10-3.27]) were associated with increased risk of 5-year mortality.

Discussion

Vulnerability, cognitive impairment, AF, and dyslipidemia at 6 months were associated with increased risks of mortality 5 years post ischemic stroke.

Conclusion

Identification and management of these risk factors should be emphasized in poststroke care.

Funding

Health Research Board (HRB) (grant numbers SPHeRE 2013/1, 1404/7400, and RL-15-1579 [to K.B.]), Irish Heart Foundation (ref. 1296829)

History

Comments

The original article is available at www.sciencedirect.com

Published Citation

Gaynor E, Rohde D, Large M, Mellon L, Hall P, Brewer L, Conway O, Hickey A, Bennett K, Dolan E, Callaly E, Williams D. Cognitive Impairment, Vulnerability, and Mortality Post Ischemic Stroke: A Five-Year Follow-Up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) Cohort. Journal of Stroke and Cerebrovascular Diseases. 2018;(9):2466-2473

Publication Date

23/05/2018

Publisher

Elsevier

PubMed ID

29803601

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