Poststroke patients with cognitive impairment at increased risk for recurrent stroke, death
Poststroke neurocognitive assessments may identify patients at a higher risk for sequelae who may require more aggressive interventions, according to the authors of a recent meta-analysis of ischemic stroke studies.
Poststroke cognitive impairment was associated with a statistically significant increase in risk of recurrent stroke and a two-fold higher risk of death, a meta-analysis found.
To estimate the risks of stroke recurrence and mortality associated with poststroke cognitive impairment, researchers collected 27 studies with 39,412 patients with ischemic stroke. The primary end points were recurrent stroke and mortality. Nine studies with 8,050 patients examined the association between cognitive impairment and recurrence while 18 with 31,362 patients looked at the association with mortality risk. Results appeared Sept. 6 in the Journal of the American Heart Association.
Recurrent stroke risk was significantly higher in patients with cognitive impairment compared with those without it (hazard ratio [HR], 1.59; 95% CI, 1.29 to 1.94). Eighteen studies examined the impact of cognitive impairment on mortality risk and found it was significant (HR, 2.07; 95% CI, 1.65 to 2.59). Meta-regressions showed that the average effect of poststroke cognitive impairment on mortality risk differed across study period and study design.
Neurocognitive assessments after stroke may identify patients at a higher risk who may require more aggressive interventions, the study authors recommended. A three- to six-month time window might be reasonable based on the observation that 81.5% of the studies performed cognitive evaluation in this time window after stroke with a median time of 91 days.
“Despite differences in mortality rate according to study design, [poststroke cognitive impairment] PSCI was associated with a significant increase in the risks of stroke recurrence and mortality in all subgroup analyses including PSCI severity and study design,” authors wrote. “These findings have significant clinical implications as PSCI may represent a promising biomarker for secondary stroke prevention risk stratification which can be tested in prospective studies and [randomized controlled trials].”