Department of Psychiatry, College of Medicine, World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, University of Ibadan, Ibadan, Nigeria.
Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Acta Neurol Scand. 2021 Sep;144(3):266-274. doi: 10.1111/ane.13442. Epub 2021 Apr 29.
There is a knowledge gap on the impact of pre-existing cognitive decline on poststroke decline in indigenous Africans. We describe the trajectories of domain-specific cognitive and activities of daily life (ADL) functioning across the first year of stroke in Nigerians with pre-existing cognitive decline.
Prospective observational study. Prestroke cognitive decline was ascertained retrospectively using the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Assessments for global cognition, learning, memory, executive and ADL functioning were conducted at 3 time points using the Mini-Mental state examination (MMSE), 10-words list learning and delayed recall test (10 WDRT), Animal naming test and Barthel index, respectively.
Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I = 11.5%-23.6%). In linear regression analyses adjusting for the effect of age, education, stroke severity and comorbid diabetes mellitus, prestroke cognitive decline predicted poor memory scores at one year [Adjusted standardized mean difference (SMD) = -0.6, 95% C.I = -1.1, -0.1, p = 0.016)]. The association of prestroke cognitive decline with poststroke poor memory was substantially mediated by age (SMD = -0.9, 95% C.I = -1.4, -0.4, p < 0.001).
Pre-existing cognitive decline in this sample was associated with an age-mediated poor memory function at one-year poststroke. Early institution of targeted cognitive rehabilitation in stroke survivors with pre-existing cognitive decline may reduce the neurocognitive burden of stroke in Black Africans.
关于预先存在的认知能力下降对非洲原住民中风后下降的影响，存在知识差距。我们描述了尼日利亚预先存在认知能力下降的患者在中风后的第一年中特定领域认知和日常生活活动（ADL）功能的轨迹。
前瞻性观察研究。使用老年认知障碍询问表（IQCODE）的 16 项条目，回顾性确定中风前的认知能力下降。使用简易精神状态检查（MMSE）、10 字列表学习和延迟回忆测试（10 WDRT）、动物命名测试和巴氏量表，分别在 3 个时间点评估总体认知、学习、记忆、执行和 ADL 功能。
在 150 例中风幸存者中，25 例（16.7%，95%置信区间[CI] 11.5%-23.6%）存在中风前认知能力下降。在调整年龄、教育、中风严重程度和合并糖尿病的影响的线性回归分析中，中风前认知能力下降预测了一年时的记忆评分差[调整后的标准化平均差异（SMD）=-0.6，95%CI-1.1，-0.1，p=0.016]。中风前认知能力下降与中风后记忆差的关系主要通过年龄（SMD=-0.9，95%CI-1.4，-0.4，p<0.001）来介导。
在该样本中，预先存在的认知能力下降与一年后记忆力下降与年龄有关。在预先存在认知能力下降的中风幸存者中，早期实施有针对性的认知康复可能会减轻非洲黑人中风的神经认知负担。
