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Stroke Specialists Call For Measure Of Physical And Mental Impairments

Measurement of both physical and cognitive impairments after stroke is needed because of their independent prognostic implications and so may influence stroke care in different ways.

Cognitive impairment, specialists add, is linked strongly to poor outcome including survival and disability up to four years after a stroke.

The call for dual evaluation comes in a paper that found that cognitive impairment, assessed by the Mini-Mental State Examination (MMSE) is common three months after a stroke - affecting 38 percent of a 645 strong sample of patients.

Researchers from Guy's Kings and St Thomas's hospital, London, England, identified a range of factors independently associated with cognitive impairment including age, ethnicity, lower social class, left hemispheric stroke, visual field defect and urinary incontinence.

Those aged 75 or older were 2.5 times more likely than younger patients to have cognitive impairment. Caribbean or African ethnicity was associated with a 1.95 times increased risk, while patients of Asian ethnicity had an odds ratio (OR) for cognitive impairment of 3.4.

Coming from a lower social class increased the likelihood of cognitive impairment by 2.1 times, and there was a similar increase in those with a visual field defect. Those with a left hemispheric defect had a lesser increased risk (OR 1.6), but urinary incontinence was strongly linked to cognitive impairment with an OR of 4.8.

Higher institutionalization four years after a stroke was linked to worse cognitive outcomes on univariate analysis.
Journal of the American Geriatrics Society, 2002; 50(4): 700-706. "Cognitive Impairment after Stroke: Clinical Determinants and Its Associations with Long-Term Stroke Outcomes"

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