Abstract T MP117: Early Cognitive Dysfunction is Associated With Poor Short Term Functional Outcome in Hospitalized Stroke Patients
Introduction: More than one-half of all patients experience cognitive dysfunction (CD) after stroke, and up to one-third develop dementia. As a Comprehensive Stroke Center, we screen all stroke inpatients for CD, though the feasibility and utility of early screening have not been established. We assessed the hypotheses that early cognitive screening in hospitalized stroke patients is feasible and that early CD is associated with poor short term functional outcome.
Methods: The medical records of all patients admitted with ischemic stroke (IS) or intracerebral hemorrhage (ICH) between 2/1/13 and 4/15/13 were reviewed. A Brief Neurocognitive Screening Test assessing registration, delayed recall, fluency, and orientation was performed (4 items from the Montreal Cognitive Assessment, higher score better; maximum 12 points). Patients were eligible if they did not have a medical condition precluding screening (e.g. death, comfort care).
Results: Of 303 IS and ICH inpatients, 209 (68.98%) were screened for CD. Over 85% of all eligible patients were screened (87.1% IS and 81.1% ICH). In a multivariate logistic regression model, factors associated with being screened for CD included lower baseline NIHSS (OR 0.91, 95% CI 0.88-0.94) and IS subtype, as compared to ICH subtype (OR 1.97, 95% CI 1.1-3.52). Median scores (IQR) for IS and ICH patients were 8 (3-10) and 5.5 (1.5-9.5), respectively. More than half of all IS and ICH patients (56.94%) screened positive for CD (score < 9). Patients most likely to screen positive for CD included those of older age (OR 1.04, 95% CI 1.02-1.06) and increased NIHSS (OR 1.14, 95% CI 1.08-1.19). Screening positive for CD was associated with poor discharge/day 7 outcome (mRS > 3), independent of age, baseline NIHSS, and stroke subtype (OR 2.37, 95% CI 1.06-5.28).
Conclusion: Screening hospitalized stroke patients for CD is feasible and CD in stroke inpatients is common. Older patients and those with more severe strokes are more likely to screen positive. Early CD is associated with poor short term functional outcome. Our results provide preliminary evidence supporting the use of early CD screening in stroke patients. Additional studies on quality of life and long-term outcome are necessary to further assess the utility of early CD screening.
Author Disclosures: R. Karamchandani: None. F. Vahidy: None. S. Bajgur: None. K. Vu: None. H. Choi: None. A. Oladunjoye: None. R. Hamilton: None. S. Savitz: None.
- © 2014 by American Heart Association, Inc.