Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry

Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry

BACKGROUND AND PURPOSE—The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. METHODS—Patients wi...

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Veröffentlicht in:Stroke (1970) 2020-06, Vol.51 (6), p.1667-1673
Hauptverfasser: Béjot, Yannick, Duloquin, Gauthier, Crespy, Valentin, Durier, Jérôme, Garnier, Lucie, Graber, Mathilde, Giroud, Maurice
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container_end_page 1673
container_issue 6
container_start_page 1667
container_title Stroke (1970)
container_volume 51
creator Béjot, Yannick
Duloquin, Gauthier
Crespy, Valentin
Durier, Jérôme
Garnier, Lucie
Graber, Mathilde
Giroud, Maurice
description BACKGROUND AND PURPOSE—The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. METHODS—Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. RESULTS—Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS6; interquartile range, 2–15), and those with dementia (n=164; median NIHSS7; interquartile range, 3–16), than in patients without cognitive impairment (n=752; median NIHSS3; interquartile range, 1–9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21–2.38]; P=0.002) and dementia (OR, 2.24 [95% CI, 1.65–3.04]; P
doi_str_mv 10.1161/STROKEAHA.119.028845
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This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. METHODS—Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. RESULTS—Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS6; interquartile range, 2–15), and those with dementia (n=164; median NIHSS7; interquartile range, 3–16), than in patients without cognitive impairment (n=752; median NIHSS3; interquartile range, 1–9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21–2.38]; P=0.002) and dementia (OR, 2.24 [95% CI, 1.65–3.04]; P&lt;0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02–2.28]; P=0.04 for MCI; OR, 2.16 [95% CI, 1.45–3.22]; P&lt;0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98–2.25]; P=0.06 for MCI, and OR, 1.98 [95% CI, 1.26–3.12]; P=0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function. CONCLUSIONS—Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.119.028845</identifier><identifier>PMID: 32397931</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><ispartof>Stroke (1970), 2020-06, Vol.51 (6), p.1667-1673</ispartof><rights>American Heart Association, Inc.</rights><rights>2020 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3505-25f28606505b13ecf58c0aa4691a964032292bfb3c4b9c170bd8bc38a09468043</cites><orcidid>0000-0001-7848-7072</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3685,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32397931$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Béjot, Yannick</creatorcontrib><creatorcontrib>Duloquin, Gauthier</creatorcontrib><creatorcontrib>Crespy, Valentin</creatorcontrib><creatorcontrib>Durier, Jérôme</creatorcontrib><creatorcontrib>Garnier, Lucie</creatorcontrib><creatorcontrib>Graber, Mathilde</creatorcontrib><creatorcontrib>Giroud, Maurice</creatorcontrib><title>Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. METHODS—Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. RESULTS—Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS6; interquartile range, 2–15), and those with dementia (n=164; median NIHSS7; interquartile range, 3–16), than in patients without cognitive impairment (n=752; median NIHSS3; interquartile range, 1–9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21–2.38]; P=0.002) and dementia (OR, 2.24 [95% CI, 1.65–3.04]; P&lt;0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02–2.28]; P=0.04 for MCI; OR, 2.16 [95% CI, 1.45–3.22]; P&lt;0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98–2.25]; P=0.06 for MCI, and OR, 1.98 [95% CI, 1.26–3.12]; P=0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function. CONCLUSIONS—Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.</description><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkUtP3DAUha2qFUwp_6CqvOwm9PoRx-5uNEAZFYmKma4jx9zMGPKY2gkw_x5DKMt2de-5-s6xdEzIZwYnjCn2bbW-vvp5Nr-YJ2lOgGst83dkxnIuM6m4fk9mAMJkXBpzSD7GeAsAXOj8gBwKLkxhBJuR3bKrmxE7h7Sv6a-A-Ojj4LsNXfSbzg_-Humy3VkfWuwG2nd00fjOO9vQFd5j8MP-2biMboutd3Q1hP4Ov9P1Fumpv038dKHXuEnBYf-JfKhtE_H4dR6R3-dn68VFdnn1Y7mYX2ZO5JBnPK-5VqDSXjGBrs61A2ulMswaJUFwbnhVV8LJyjhWQHWjKye0BSOVBimOyNcpdxf6PyPGoWx9dNg0tsN-jCWXwKVkTBcJlRPqQh9jwLrcBd_asC8ZlM9dl29dJ2nKqetk-_L6wli1ePNm-ltuAvQEPPTNgCHeNeMDhnKLthm2_8uW_7Cmj4RCFZBx4AAqqezlJJ4AdkCcjA</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Béjot, Yannick</creator><creator>Duloquin, Gauthier</creator><creator>Crespy, Valentin</creator><creator>Durier, Jérôme</creator><creator>Garnier, Lucie</creator><creator>Graber, Mathilde</creator><creator>Giroud, Maurice</creator><general>American Heart Association, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7848-7072</orcidid></search><sort><creationdate>20200601</creationdate><title>Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry</title><author>Béjot, Yannick ; Duloquin, Gauthier ; Crespy, Valentin ; Durier, Jérôme ; Garnier, Lucie ; Graber, Mathilde ; Giroud, Maurice</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3505-25f28606505b13ecf58c0aa4691a964032292bfb3c4b9c170bd8bc38a09468043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Béjot, Yannick</creatorcontrib><creatorcontrib>Duloquin, Gauthier</creatorcontrib><creatorcontrib>Crespy, Valentin</creatorcontrib><creatorcontrib>Durier, Jérôme</creatorcontrib><creatorcontrib>Garnier, Lucie</creatorcontrib><creatorcontrib>Graber, Mathilde</creatorcontrib><creatorcontrib>Giroud, Maurice</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Béjot, Yannick</au><au>Duloquin, Gauthier</au><au>Crespy, Valentin</au><au>Durier, Jérôme</au><au>Garnier, Lucie</au><au>Graber, Mathilde</au><au>Giroud, Maurice</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>51</volume><issue>6</issue><spage>1667</spage><epage>1673</epage><pages>1667-1673</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>BACKGROUND AND PURPOSE—The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. METHODS—Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and severity was evaluated using ordinal regression analysis models in which the NIHSS score was considered as a categorical variable. RESULTS—Among the 1048 patients (mean age, 76.3±15.2 years; 54.0% women), a greater severity was observed in those with MCI (n=132; median NIHSS6; interquartile range, 2–15), and those with dementia (n=164; median NIHSS7; interquartile range, 3–16), than in patients without cognitive impairment (n=752; median NIHSS3; interquartile range, 1–9). MCI (odds ratio [OR], 1.70 [95% CI, 1.21–2.38]; P=0.002) and dementia (OR, 2.24 [95% CI, 1.65–3.04]; P&lt;0.001) were both associated with a greater severity at onset. The association was still observed after adjustment for clinical variables and proximal arterial occlusion (OR, 1.52 [95% CI, 1.02–2.28]; P=0.04 for MCI; OR, 2.16 [95% CI, 1.45–3.22]; P&lt;0.001 dementia). Further adjustment for prestroke handicap slightly reduced the magnitude of the association (OR, 1.49 [95% CI, 0.98–2.25]; P=0.06 for MCI, and OR, 1.98 [95% CI, 1.26–3.12]; P=0.02 for dementia). The greater severity in patients with prestroke cognitive impairment was not specifically driven by a more severe impairment of either motor or language function. CONCLUSIONS—Patients with preexisting cognitive impairment suffered more severe ischemic stroke. This result could reflect a lower brain tolerance of acute ischemia. Further studies are needed to explore the underlying mechanisms that could be targeted from therapeutic perspectives focusing on neuroprotection.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>32397931</pmid><doi>10.1161/STROKEAHA.119.028845</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7848-7072</orcidid></addata></record>
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title Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry
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