The impact of early-life intelligence quotient on post stroke cognitive impairment

Makin, S. D.J., Doubal, F. N., Shuler, K., Chappell, F. M., Staals, J., Dennis, M. S. and Wardlaw, J. M. (2018) The impact of early-life intelligence quotient on post stroke cognitive impairment. European Stroke Journal, 3(2), pp. 145-156. (doi: 10.1177/2396987317750517)

Abstract

Background: Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods: We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1–3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke’s Cognitive Examination–Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). Results: We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56–74) years, 36/157 (23%) patients had a Addenbrooke’s Cognitive Examination–Revised score < 82 at one to three months, 29/151 (19%) had a Addenbrooke’s Cognitive Examination–Revised < 82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). Discussion: This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion: Pre-morbid intelligence should be considered in future studies of post-stroke cognition.

• Item Type: Articles
• Additional Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Wellcome Trust (grant 088134/Z/09/A); Scottish Funding Council and the Chief Scientist Office of Scotland for funding the Scottish Imaging Network: A Platform for Scientific Excellence (‘SINAPSE’). FD holds a NHS Research Scotland and Stroke Association-Garfield Weston Foundation Senior Lectureship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Makin, Dr Stephen
• Authors: Makin, S. D.J., Doubal, F. N., Shuler, K., Chappell, F. M., Staals, J., Dennis, M. S., and Wardlaw, J. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Stroke Journal
• Publisher: SAGE Publications
• ISSN: 2396-9873
• ISSN (Online): 2396-9881
• Published Online: 08 January 2018
• Copyright Holders: Copyright © 2018 European Stroke Organisation
• First Published: First published in European Stroke Journal 3(2):145-156
• Publisher Policy: Reproduced in accordance with the publisher copyright policy