Background: Cognitive symptoms are easily overlooked despite its effect on quality of life after stroke. In patients with minimal physical residual symptoms, the true burden of cognitive impairment is unknown.
Objective: To evaluate the risk factors and burden associated with cognitive impairment after mild stroke.
Methods: A retrospective observational cohort study of 56 patients (51 ischemic, 5 hemorrhagic) evaluated at the stroke clinic between July 2016 and June 2017 was performed. Patients completed a questionnaire including demographics and history including previously known cognitive impairment. Cognition was evaluated with the Montreal Cognitive Assessment Score (MOCA).
Results: The median age of the group studied was 61.5 years. Sixty-six percent (66.1%) patients were men and 76.8% Caucasian. The median discharge NIH score was 1. This study group did not have a previous diagnosis of dementia. About 4% (n=2) of patients presented to clinic <6 weeks, 71.4% (n=40) 6-12 weeks, 17.9% (n=10) 12-24weeks and 7.1% (n=4) >24 weeks from discharge. Cognitive assessment at the stroke clinic after discharge identified 19.6% patients with mild impairment, 16.1% with moderate impairment and 14.3% with dementia. MOCA scores were lower in those greater than 65 years of age (p=0.022), living in facilities post-stroke (p=0.007), have history of stroke and diabetes mellitus (p=0.011, 0.019). Education level did not show significant difference in MOCA scores (p=0.283). Those who were employed prior to their stroke have a higher MOCA score compared to those who were unemployed (p=0.001). Of those previously working, 50% were able to return to work and this group had higher MOCA scores (p=0.011). Of those who stopped driving, 19.6% was due to cognitive concerns.
Conclusion: In our study, about 50% of the mild stroke patients were found to have some degree of cognitive impairment. Factors that may suggest a higher risk for cognitive impairment after stroke include those age greater than 65, history of stroke and diabetes, unemployment and living in a facility. Post-stroke cognitive impairment was found to be associated with inability to return to work and drive. Since cognitive impairment can impact life quality, screening even in mild stroke could be beneficial.