Pre-stroke frailty is independently associated with post-stroke cognition: A cross-sectional study

Taylor-Rowan, M. , Keir, R., Cuthbertson, G., Shaw, R., Drozdowska, B. , Elliott, E., Evans, J. , Stott J, D. and Quinn, T. J. (2019) Pre-stroke frailty is independently associated with post-stroke cognition: A cross-sectional study. Journal of the International Neuropsychological Society, 25(5), pp. 501-506. (doi: 10.1017/S1355617719000092) (PMID:30821222)

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, 00, 1–6)

• Item Type: Articles
• Additional Information: MT is partially funded by Chest Heart & Stroke Scotland; this work is part of the APPLE program of work funded by the Stroke Association and Chief Scientist Office Scotland. TQ is supported by a joint Stroke Association/Chief Scientist Office Senior Clinical Lectureship award.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor-Rowan, Dr Martin and Evans, Professor Jonathan and Elliott, Emma and Stott J, Professor David and Drozdowska, Bogna and Shaw, Mr Robert and Quinn, Professor Terry
• Authors: Taylor-Rowan, M., Keir, R., Cuthbertson, G., Shaw, R., Drozdowska, B., Elliott, E., Evans, J., Stott J, D., and Quinn, T. J.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of the International Neuropsychological Society
• Publisher: Cambridge University Press
• ISSN: 1355-6177
• ISSN (Online): 1469-7661
• Published Online: 01 March 2019
• Copyright Holders: Copyright © 2019 The International Neuropsychological Society
• First Published: First published in Journal of the International Neuropsychological Society 25(5):501-506
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher