A prospective cohort study on longitudinal trajectories of cognitive function after stroke

Dongni Buvarp, Lena Rafsten, Tamar Abzhandadze, Katharina S Sunnerhagen, Dongni Buvarp, Lena Rafsten, Tamar Abzhandadze, Katharina S Sunnerhagen

Abstract

The study aimed to determine longitudinal trajectories of cognitive function during the first year after stroke. The Montreal Cognitive Assessment (MoCA) was used to screen cognitive function at 36-48 h, 3-months, and 12-months post-stroke. Individuals who shared similar trajectories were classified by applying the group-based trajectory models. Data from 94 patients were included in the analysis. Three cognitive functioning groups were identified by the trajectory models: high [14 patients (15%)], medium [58 (62%)] and low [22 (23%)]. For the high and medium groups, cognitive function improved at 12 months, but this did not occur in the low group. After age, sex and education matching to the normative MoCA from the Swedish population, 52 patients (55%) were found to be cognitively impaired at baseline, and few patients had recovered at 12 months. The impact on memory differs between cognitive functioning groups, whereas the impact on activities of daily living was not different. Patients with the poorest cognitive function did not improve at one-year poststroke and were prone to severe memory problems. These findings may help to increase focus on long-term rehabilitation plans for those patients, and more accurately assess their needs and difficulties experienced in daily living.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Flow chart summarizing study sample recruitment and inclusion and exclusion for longitudinal data analysis. a94 patients who had two or more longitudinal assessments of MoCA were included into the analysis.
Figure 2
Figure 2
(A) Individual changes in total MoCA score over time in the different cognitive functioning groups (high, medium and low) and mean total MoCA scores of each cognitive functioning group are shown. (B) Percent of patients with cognitive impairment within each cognitive functioning group after age, sex and education-matching with the Swedish population. The light brown line represents the mean total MoCA of patients with cognitive impairment for each group. MoCA Montreal Cognitive Assessment, CI confidence interval, mos months.
Figure 3
Figure 3
Mean scores of MoCA subdomains by different cognitive functioning groups over time. The black dash lines represent the maximum score of each subdomain. MoCA Montreal Cognitive Assessment, CI confidence interval, mos months.
Figure 4
Figure 4
Impact on memory and activities of daily living by different cognitive functioning groups across 3 time points. Data available for SIS-memory and thinking in 93 patients at baseline, 87 patients at 3 and 12 months. Data available for SIS-ADL/IADL in 88 patients at baseline, 87 at 3 and 12 months. *p < 0.05, **p < 0.01, ***p < 0.001. SIS stroke impact scale, CI confidence interval, ADL activities of daily living, IADL instrumental activities of daily living.

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