Abstract
Background and Purpose: Cognitive impairment occurs in 20%-40% of stroke patients and is a predictor of long-term
morbidity and mortality. In this study, we aim to determine the association between
poststroke cognitive impairment and stroke recurrence risk, in patients with anterior
versus posterior circulation intracranial stenosis. Methods: This is a post-hoc analysis of the Stenting and Aggressive Medical Therapy for Preventing
Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. The primary predictor
was poststroke cognitive function measured by Montreal Cognitive Assessment (MOCA)
at 3-6 months and the primary outcome was recurrent ischemic stroke. We used univariate
and multivariable cox-regression models to determine the associations between MOCA
at 3-6 months and recurrent stroke. Results: Of the 451 patients enrolled in SAMMPRIS, 393 patients met the inclusion criteria.
The mean age of the sample (in years) was 59.5 ± 11.3, 62.6% (246 of 393) were men.
Fifty patients (12.7%) had recurrent ischemic stroke during a mean follow up of 2.7
years. The 3-6 month MOCA score was performed on 351 patients. In prespecified multivariable
models, there was an association between 3 and 6 month MOCA and recurrent stroke (hazard
ratio [HR] per point increase .93 95% confidence interval [CI] .88-.99, P = .040). This effect was present in anterior circulation stenosis (adjusted HR per
point increase .92 95% CI .85-0.99, P = .022) but not in posterior circulation artery stenosis (adjusted HR per point increase
1.00 95% .86-1.16, P = .983). Conclusions: Overall, we found weak associations and trends between MoCA at 3-6 months and stroke
recurrence but more notable and stronger associations in certain subgroups. Since
our study is underpowered, larger studies are needed to validate our findings and
determine the mechanism(s) behind this association.
Key Words
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Article info
Publication history
Published online: February 07, 2020
Accepted:
January 11,
2020
Received in revised form:
January 3,
2020
Received:
December 10,
2019
Footnotes
Financial disclosures: SAMMPRIS was funded by the National Institute of Neurological Disorders and Stroke (grant no. U01 NS058728).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104663
Copyright
© 2020 Elsevier Inc. All rights reserved.
