Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2012, KS 66207, USA.
Overland Park Regional Medical Center, USA.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106132. doi: 10.1016/j.jstrokecerebrovasdis.2021.106132. Epub 2021 Oct 24.
Many survivors of a mild ischemic stroke do not return to work or driving. Cognitive testing is commonly done to assess long-term cognitive impairment after stroke. Inpatient cognitive testing during the acute period of ischemic stroke may also be a predictor for workforce reengagement and functional outcome.
At our comprehensive stroke center, we prospectively enrolled previously working adults < 65 years old who were diagnosed with first-ever ischemic stroke, had a prestroke modified Rankin Scale (mRS) ≤ 1 and NIHSS ≤ 3. Testing performed within 1 week of stroke included the Montreal Cognitive Assessment (MOCA), Clock Drawing Test (CDT), Trail Making Tests A and B, Backward Digit Span Test, and Hospital Anxiety and Depression Scale (HADS). Other data obtained included age, gender, years of education, occupation, stroke location, stroke laterality, and presence of white matter disease on imaging. Outcome measures assessed at 3 months, 6 months, and 12 months post-stroke included return to work, return to driving, and mRS. In a logistic regression analysis, we performed both univariate and multivariate analyses. Multivariate analysis was completed on variables with p-value ≤ 0.05 in the univariate analysis.
Of 39 total stroke patients enrolled and tested (median [IQR] age 55 [46-60] years; 77.5% male; 22.5% female), 36 completed 3-month follow up, of which 58% returned to work, 78% returned to driving, and 72% had mRS of 0-1. In multivariate analysis, a single point increase in the clock drawing task score increased the odds of return to work by 3.79 (95% CI, 1.10-14.14) and return to driving by 6.74 (95% CI, 1.22-37.23) at 3 months. MOCA and HADS were both associated with mRS ≤ 1. MOCA was associated with return to work at 6 months and CDT was associated with return to work at 12 months.
Cognitive testing with CDT and MOCA in the acute period after ischemic stroke may predict common patient goals post stroke, including return to work, driving, and independence. These tools can potentially be used for prognosis and identifying those who may benefit from further interventions.
许多轻度缺血性中风幸存者无法重返工作或驾驶岗位。认知测试常用于评估中风后长期认知障碍。在缺血性中风的急性期进行住院认知测试，也可能预测劳动力重新参与和功能结局。
在我们的综合中风中心，我们前瞻性纳入了首次诊断为缺血性中风、发病前改良 Rankin 量表（mRS）≤1 且 NIHSS≤3 的<65 岁有工作的成年人。在中风后 1 周内进行的测试包括蒙特利尔认知评估（MOCA）、画钟测验（CDT）、连线测试 A 和 B、倒背数字广度测验和医院焦虑抑郁量表（HADS）。获得的其他数据包括年龄、性别、受教育年限、职业、中风部位、中风侧、影像学上的白质病变。在中风后 3 个月、6 个月和 12 个月评估的结局测量包括重返工作、重返驾驶和 mRS。在单变量和多变量分析中，我们进行了逻辑回归分析。在单变量分析中 p 值≤0.05 的变量进行了多变量分析。
共纳入 39 例中风患者进行测试（中位 [IQR]年龄 55 [46-60]岁；77.5%男性；22.5%女性），36 例完成 3 个月随访，其中 58%重返工作，78%重返驾驶，72%mRS 为 0-1。在多变量分析中，CDT 得分增加 1 分，3 个月时重返工作的几率增加 3.79 倍（95%CI，1.10-14.14），重返驾驶的几率增加 6.74 倍（95%CI，1.22-37.23）。MOCA 和 HADS 均与 mRS≤1 相关。MOCA 与 6 个月时的重返工作相关，CDT 与 12 个月时的重返工作相关。
在缺血性中风后的急性期进行 CDT 和 MOCA 认知测试可能预测中风后患者的常见目标，包括重返工作、驾驶和独立。这些工具可用于预测预后，识别可能受益于进一步干预的患者。
