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Pre-Stroke Frailty Is Independently Associated With Post-Stroke Cognition: A Cross-Sectional Study

Published online by Cambridge University Press:  01 March 2019

Martin Taylor-Rowan Open the ORCID record for Martin Taylor-Rowan [Opens in a new window] ,
Ruth Keir ,
Gillian Cuthbertson ,
Robert Shaw ,
Bogna Drozdowska ,
Emma Elliott ,
Jonathan Evans ,
David Stott  and
Terence J. Quinn
Martin Taylor-Rowan*
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Ruth Keir
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Gillian Cuthbertson
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Robert Shaw
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Bogna Drozdowska
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Emma Elliott
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Jonathan Evans
Affiliation:
Institute of Health and Wellbeing, University of Glasgow, UK
David Stott
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Terence J. Quinn
Affiliation:
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
*
Correspondence and reprint requests to: Martin Taylor-Rowan, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 8-16 Alexandra Parad, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK G4 0SF. E-mail: m.taylor-rowan.1@research.gla.ac.uk
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Abstract

Objective: Post-stroke cognitive impairment is common, but mechanisms and risk factors are poorly understood. Frailty may be an important risk factor for cognitive impairment after stroke. We investigated the association between pre-stroke frailty and acute post-stoke cognition. Methods: We studied consecutively admitted acute stroke patients in a single urban teaching hospital during three recruitment waves between May 2016 and December 2017. Cognition was assessed using the Mini-Montreal Cognitive Assessment (min=0; max=12). A Frailty Index was used to generate frailty scores for each patient (min=0; max=100). Clinical and demographic information were collected, including pre-stroke cognition, delirium, and stroke-severity. We conducted univariate and multiple-linear regression analyses with covariates forced in (covariates included were: age, sex, stroke severity, stroke-type, pre-stroke cognitive impairment, delirium, previous stroke/transient ischemic attack) to investigate the association between pre-stroke frailty and post-stroke cognition. Results: Complete data were available for 154 stroke patients. Mean age was 68 years (SD=11; range=32–97); 93 (60%) were male. Median mini-Montreal Cognitive Assessment score was 8 (IQR=4–12). Mean Frailty Index score was 18 (SD=11). Pre-stroke cognitive impairment was apparent in 13/154 (8%) patients. Pre-stroke frailty was significantly associated with lower post-stroke cognition (Standardized-Beta=−0.40; p<0.001) and this association was independent of covariates (Unstandardized-Beta=−0.05; p=0.005). Additional significant variables in the multiple regression model were age (Unstandardized-Beta=−0.05; p=0.002), delirium (Unstandardized-Beta=−2.81; p<0.001), pre-stroke cognitive impairment (Unstandardized-Beta=−2.28; p=0.001), and stroke-severity (Unstandardized-Beta=−0.20; p<0.001). Conclusions: Pre-stroke frailty may be a moderator of post-stroke cognition, independent of other well-established post-stroke cognitive impairment risk factors. (JINS, 2019, 25, 501–506)

Keywords

StrokeFrailtyCognitionRiskEtiologyCerebrovascular
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 5 , May 2019 , pp. 501 - 506
Copyright
Copyright © The International Neuropsychological Society 2019 

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