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Cognitive impairment in lacunar strokes: The SPS3 trial
Author(s) -
Jacova Claudia,
Pearce Lesly A.,
Costello Raymond,
McClure Leslie A.,
Holliday Stephen L.,
Hart Robert G.,
Benavente Oscar R.
Publication year - 2012
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23733
Subject(s) - dementia , stroke (engine) , neuropsychology , lacunar stroke , cognitive impairment , cohort , verbal fluency test , memory impairment , medicine , physical therapy , psychology , cognition , audiology , psychiatry , disease , ischemic stroke , ischemia , mechanical engineering , engineering
Abstract Objective: Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. Methods: All English‐speaking participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (National Clinical Trial 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z scores using published norms. Those with impairment ( z ≤ −1.5) in memory and/or nonmemory domains were classified as having mild cognitive impairment (MCI). Results: Among the 1,636 participants, average z scores on all tests were <0, with the largest deficits seen on tests of episodic memory (range of means, −0.65 to −0.92), verbal fluency (mean, −0.89), and motor dexterity (mean, −2.5). Forty‐seven percent were classified as having MCI (36% amnestic, 37% amnestic multidomain, 28% nonamnestic). Of those with modified Rankin score 0–1 and Barthel score = 100, 41% had MCI. Younger age (odds ratio [OR] per 10‐year increase, 0.87), male sex (OR, 1.3), less education (OR, 0.13–0.66 for higher education levels compared to 0–4 years education), poststroke disability (OR, 1.4), and impaired activities of daily living (OR, 1.8) were independently associated with MCI. Interpretation: In this large, well‐characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae. ANN NEUROL 2012;72:351–362