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(Stroke. 2009;40:2473.)
© 2009 American Heart Association, Inc.

Original Contributions

Hidden Dysfunctioning in Subacute Stroke

Assia Jaillard, MD, PhD; Bernadette Naegele, PhD; Sandra Trabucco-Miguel, PhD; Jean François LeBas, MD, PhD Marc Hommel, MD

From the Institut Fédératif de Recherche (A.J., J.F.L.), Unité d’Imagerie par Résonance Magnétique, Pôle Imagerie CHU Grenoble, France; Grenoble Institut des Neurosciences (A.J., B.N., J.F.L.), Inserm U.836, Equipe 5, Neuroimagerie Fonctionnelle et Métabolique, Grenoble, France; Unité Neurovasculaire (B.N., S.T.-M.), Pôle Neurologie-Psychiatrie, CHU Grenoble, France; and Centre d’Investigations cliniques (M.H.), INSERM CIC 003 CHU Grenoble, France.

Correspondence to Assia Jaillard, MD, PhD, Unité d’IRM, IRF 1-Pôle Imagerie, CHU Grenoble, BP 217-38043 Grenoble-Cedex 09, France. E-mail Assia.Jaillard{at}ujf-grenoble.fr

Background and Purpose— Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF.

Methods— Patients with Mini-Mental State Examination scores 23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education- and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression.

Results— Among 177 patients (mean age, 50.6 years), 91.5% failed in at least one cognitive domain. WM was the most impaired domain (87.6%) with executive functions (64.4%), episodic memory (64.4%), and instrumental functions (24.9%) being relatively preserved. CDF was associated with age, education, depression, neurological deficit, and leukoaraiosis in bivariate analysis. Using logistic regression, WM tests and age predicted CDF (Modified Paced Auditorial Serial Addition Test: OR=0.96 CI=0.93 to 0.98; Owen-spatial-WM: OR=1.07 CI=1.02 to 1.12; age: OR=0.96 CI=0.93 to 0.98).

Conclusion— CDF appears to be almost constant, although underestimated, in subacute stroke. WM could reflect some hidden dysfunctioning, which may interfere with rehabilitation and return to work. Clinical routine may include WM tests in young patients with mild stroke.

Supplemental Appendix