Determinants of post‐stroke cognitive impairment: analysis from VISTA

Background Post‐stroke cognitive impairment ( PSCI ) occurs commonly and is linked with development of dementia. We investigated the relationship between demographic, clinical and stroke symptoms at stroke onset and the presence of PSCI at 1 and 3 years after stroke. Methods We accessed anonymized data from the Virtual International Stroke Trial Archive ( VISTA ), including demographic and clinical variables. Post‐stroke cognitive impairment was defined as a Mini‐Mental State Examination ( MMSE ) score of ≤26. We assessed univariate relationships between baseline stroke symptoms and PSCI at 1 and 3 years following stroke, retaining the significant and relevant clinical factors as covariates in a final adjusted logistic regression model. Results We analysed data on 5435 patients with recent (median 33 days) stroke or transient ischaemic attack ( TIA ). Mean (± SD ) age was 62.6 (±12.6) years; 3476 (65%) patients were male. Follow‐up data were available for 2270 and 1294 patients at 1 and 3 years, respectively. At 1 year, 781 (34%) patients had MMSE ≤26; at 3 years, 391 (30%) had MMSE ≤26. After adjusting for age, stroke severity, hypertension, diabetes and type of qualifying event, initial stroke impairment (leg paralysis) was associated with increased rate of PSCI at 1 year ( OR =1.62; 95% CI =1.20–2.20) and at 3 years ( OR =1.95; 95% CI =1.23–3.09). Associations were consistent on subgroup analysis restricted to ischaemic stroke and transient ischaemic attack (N=4992). Conclusions Besides well‐known determinants of PSCI such as age, stroke severity and the presence of vascular risk factors, also leg paralysis is associated with subsequent of PSCI up to 3 years after stroke.