From the Departments of Neurology (C.S.K., P.A.W., M.K.-H.) and Medicine
(W.B.K.), Boston University School of Medicine, Department of Biostatistics
and Epidemiology, Boston University School of Public Health (A.B.), and
Department of Mathematics, Boston University (R.B.D'A.), Boston, Mass,
and the Framingham Study, National Heart, Lung, and Blood Institute,
Framingham, Mass.
Correspondence to Carlos S. Kase, MD, Department of Neurology, Boston University School of Medicine, 80 East Concord St, B-605, Boston, MA 02118. E-mail cskase{at}bu.edu
Background and Purpose—The causes
and characteristics of cognitive decline after stroke are poorly
defined, because most studies have relied on the diagnosis of dementia
after stroke, without measurement of prestroke cognitive function.
Methods—The Mini-Mental State Examination (MMSE) was used to
assess the cognitive performance of 74 subjects from the
Framingham Study cohort who had suffered a stroke during a 13-year
period. We compared their poststroke cognitive performance with
the prestroke MMSE scores collected during their biennial examinations,
and their prestroke/poststroke changes in MMSE score were then compared
with those of 74 control subjects matched for age and sex. Cases and
controls underwent testing for symptoms of depression using the Center
for Epidemiologic Studies of Depression (CES-D) scale, and these
findings were correlated with their cognitive performance.
Changes in cognitive performance in the cases were correlated
with the CT-documented characteristics of the stroke.
Results—The cases had a significantly lower mean±SE MMSE score
at prestroke baseline (27.28±0.34) than did the control subjects
(28.08±0.21), a difference that became more pronounced (23.57±0.92
versus 28.31±0.25; P<.001) after stroke. The
poststroke decline in cognitive function in the cases was correlated
only with a large, left-sided stroke on CT. The CES-D scores were
significantly higher in the cases, but nondepressed cases had
significantly lower MMSE scores than nondepressed controls.
Conclusions—Stroke is followed by a significant decline in
cognitive performance when prestroke and poststroke
measurements are compared. Although depression is more frequent in the
stroke patients, their intellectual decline appears to be independent
from the presence of depression.
© 1998 American Heart Association, Inc.
Original Contributions
Intellectual Decline After Stroke
The Framingham Study
Key Words: dementia • depression • neuropsychological tests • stroke
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