Abstract 168: Prevalence And Characterization Of Neuropsychological Deficits In Lacunar Stroke Patients. The Secondary Prevention Of Small Subcortical Strokes (sps3) Trial
Background: Though the important role of lacunar stroke in cognitive impairment and dementia is widely recognized, to date no well-characterized pattern of neuropsychological (NP) impairment has been defined in this stroke subtype.
Methods: SPS3 is a multi-center international randomized trial that included a well-defined cohort of MRI proven lacunar stroke patients. For the purpose of this analysis we consider NP testing data collected at study entry for all English speaking participants enrolled in North America. The hour-long NPT was administered by a certified examiner and covered a wide range of domains. Raw test scores were converted to standardized scores using normative data which were then entered into a principal component analysis to identify distinct cognitive domains measured. NP status was defined as Not Cognitively Impaired (NCI) and Mild Cognitive Impairment (MCI) if there was impairment in memory and/or non-memory domains.
Results: Of the 3020 SPS3 participants, 1632 were included in these analyses. Most (85%) scored ≥95 on the Barthel Index. Performances (z-scores) on all NPT were lower than normal for age, and for education and gender. The largest deficits were seen on tests of episodic memory (mean -0.92 to -0.68), verbal fluency (mean -0.89), and motor dexterity (median -2.5). The magnitude of cognitive impairment increased with higher Rankin scores (p < 0.001). Principal component analysis revealed memory and two non-memory domains (perceptual-verbal processing speed, executive functioning). Based on these domains, NP status was 53% NCI, 17% amnestic MCI, 17% amnestic multidomain MCI, and 13% non-amnestic MCI.
Conclusion: In this large and well-defined cohort of lacunar stroke patients, MCI was present in half of the cohort. The most significant impairments were found on tests of processing speed, motor dexterity, executive function, and episodic memory. Episodic memory appears a central feature in this cohort and should be assessed carefully in future clinical studies and trials directed at subcortical stroke populations. NP deficits appear to be more prevalent than functional deficits (Barthel) in survivors of lacunar stroke.
- © 2012 by American Heart Association, Inc.