Cognitive function and outcomes post-stroke: a five-year follow-up of the ASPIRE-S cohort

Abstract

Introduction: Impairments in cognitive function are common following stroke and can increase disability and levels of dependency, resulting in increased burden on family members or carers, as well as the healthcare system. The aims of this study were to examine cognitive function trajectories in a cohort of stroke patients from six months to five years post-stroke, and to explore the outcomes associated with post-stroke cognitive decline. Methods: 5-year follow-up of the ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) cohort study of stroke patients, involving a detailed assessment of cognitive function, secondary prevention and health care utilisation. 256 patients were last assessed at six months post-stoke, with c.180 being reassessed at 5-year follow up. Logistic regression analysis is based on data from the first half of this follow-up study. Findings: Out of 256 patients last seen six months post-stroke, 52 (20.3%) had died at 5-year follow-up. Cognitive impairment (MoCA <26) at six months was significantly associated with death at five years (aOR 2.98, 95%CI 1.12 to 7.91), controlling for age, modified Rankin Scale assessed 72 hours post-stroke, and number of cardiovascular risk factors. Associations between cognitive decline and secondary prevention, recurrent events, and costs in terms of quality of life and healthcare utilisation, will also be presented. Discussion: Post-stroke cognitive impairment is associated with mortality at five years, highlighting the potential importance of cognitive interventions and rehabilitation post-stroke.