Ann Rehabil Med.  2017 Oct;41(5):734-742. 10.5535/arm.2017.41.5.734.

The Characteristics of Cognitive Impairment and Their Effects on Functional Outcome After Inpatient Rehabilitation in Subacute Stroke Patients

• Park SH
• Sohn MK
• Jee S
• Yang SS

• KMID: 2440799
• DOI: http://doi.org/10.5535/arm.2017.41.5.734

Abstract

OBJECTIVE
To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation.
METHODS
We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke.
RESULTS
Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R²=0.646).
CONCLUSION
In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.

Keyword

Stroke; Cognitive symptom; Outcome assessment

MeSH Terms

Cognition
Cognition Disorders*
Executive Function
Humans
Inpatients*
Medical Records
Memory
Multivariate Analysis
Neurobehavioral Manifestations
Rehabilitation Centers
Rehabilitation*
Retrospective Studies
Stroke*

Figure

• 

  Fig. 1 Study flow chart. K-VCIHS, Korean version of Vascular Cognitive Impairment Harmonization Standards.

Reference

1. Seshadri S, Wolf PA. Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. Lancet Neurol. 2007; 6:1106–1114. PMID: 18031707.

2. Jin YP, Di Legge S, Ostbye T, Feightner JW, Hachinski V. The reciprocal risks of stroke and cognitive impairment in an elderly population. Alzheimers Dement. 2006; 2:171–178. PMID: 19595880.

3. Hachinski VC, Bowler JV. Vascular dementia. Neurology. 1993; 43:2159–2160.

4. Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42:2672–2713. PMID: 21778438.

5. Delgado C, Donoso A, Orellana P, Vasquez C, Diaz V, Behrens MI. Frequency and determinants of poststroke cognitive impairment at three and twelve months in Chile. Dement Geriatr Cogn Disord. 2010; 29:397–405. PMID: 20484909.

6. Serrano S, Domingo J, Rodriguez-Garcia E, Castro MD, del Ser T. Frequency of cognitive impairment without dementia in patients with stroke: a two-year follow-up study. Stroke. 2007; 38:105–110. PMID: 17158334.

7. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006; 37:2220–2241. PMID: 16917086.

8. Yu KH, Cho SJ, Oh MS, Jung S, Lee JH, Shin JH, et al. Cognitive impairment evaluated with Vascular Cognitive Impairment Harmonization Standards in a multicenter prospective stroke cohort in Korea. Stroke. 2013; 44:786–788. PMID: 23271507.

9. Mann LL, Wong K. Development of an objective method for assessing viscosity of formulated foods and beverages for the dysphagic diet. J Am Diet Assoc. 1996; 96:585–588. PMID: 8655906.

10. Joy S, Kaplan E, Fein D. Speed and memory in the WAIS-III Digit Symbol: coding subtest across the adult lifespan. Arch Clin Neuropsychol. 2004; 19:759–767. PMID: 15288329.

11. Heruti RJ, Lusky A, Dankner R, Ring H, Dolgopiat M, Barell V, et al. Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome. Arch Phys Med Rehabil. 2002; 83:742–749. PMID: 12048650.

12. O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, et al. Vascular cognitive impairment. Lancet Neurol. 2003; 2:89–98. PMID: 12849265.

13. Nys GM, van Zandvoort MJ, de Kort PL, van der Worp HB, Jansen BP, Algra A, et al. The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology. 2005; 64:821–827. PMID: 15753416.

14. Wagle J, Farner L, Flekkoy K, Bruun Wyller T, Sandvik L, Fure B, et al. Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months. Dement Geriatr Cogn Disord. 2011; 31:379–387. PMID: 21720162.

15. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993; 43:250–260. PMID: 8094895.

16. Park JH, Kim BJ, Bae HJ, Lee J, Lee J, Han MK, et al. Impact of post-stroke cognitive impairment with no dementia on health-related quality of life. J Stroke. 2013; 15:49–56. PMID: 24324939.

17. Qu Y, Zhuo L, Li N, Hu Y, Chen W, Zhou Y, et al. Prevalence of post-stroke cognitive impairment in china: a community-based, cross-sectional study. PLoS One. 2015; 10:e0122864. PMID: 25874998.

18. Petersen SE, Posner MI. The attention system of the human brain: 20 years after. Annu Rev Neurosci. 2012; 35:73–89. PMID: 22524787.

19. Liu T, Slotnick SD, Serences JT, Yantis S. Cortical mechanisms of feature-based attentional control. Cereb Cortex. 2003; 13:1334–1343. PMID: 14615298.

20. Egner T, Monti JM, Trittschuh EH, Wieneke CA, Hirsch J, Mesulam MM. Neural integration of top-down spatial and feature-based information in visual search. J Neurosci. 2008; 28:6141–6151. PMID: 18550756.

21. Skidmore ER, Whyte EM, Holm MB, Becker JT, Butters MA, Dew MA, et al. Cognitive and affective predictors of rehabilitation participation after stroke. Arch Phys Med Rehabil. 2010; 91:203–207. PMID: 20159122.

22. Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke: a critical review of the literature. Age Ageing. 1996; 25:479–489. PMID: 9003886.

23. Donaldson SW, Wagner CC, Gresham GE. A unified ADL evaluation form. Arch Phys Med Rehabil. 1973; 54:175–179. PMID: 4697224.

24. Novak S, Johnson J, Greenwood R. Barthel revisited: making guidelines work. Clin Rehabil. 1996; 10:128–134.

25. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke. 2011; 42:1146–1151. PMID: 21372310.

26. Rossini ED, Karl MA. The Trail Making Test A and B: a technical note on structural nonequivalence. Percept Mot Skills. 1994; 78:625–626. PMID: 8022690.

27. Laska AC, Hellblom A, Murray V, Kahan T, Von Arbin M. Aphasia in acute stroke and relation to outcome. J Intern Med. 2001; 249:413–422. PMID: 11350565.