Clinical characteristics of cognitive impairment and its related risk factors in post-stroke epilepsy.

OBJECTIVE

Post-stroke epilepsy (PSE) patients are prone to cognitive impairment (CI) due to multiple factors. This study aimed to assess clinical characteristics of CI and its related risk factors in newly diagnosed Chinese Han adult epilepsy patients with ischaemic stroke.

METHODS

Data were collected on PSE patients hospitalized in the neurology ward of the Affiliated Hospital of Yangzhou University, from January 2016 to May 2019. Newly diagnosed PSE patients were followed for six months; their cognitive functions were then assessed according to the Chinese Beijing version of the Montreal Scale (MoCA) and patients were divided into a PSE+CI group (MoCA scale score <26) (n=81) or PSE-CI group (MoCA scale score ≥26) (n=36). Data collection tools also included the Chinese versions of the Zheng Self-assessment Anxiety Scale, the Zheng Self-assessment Depression Scale, the Barthel index and the National Hospital Seizure Severity Scale. We compared the basic clinical characteristics between the two groups of patients and investigated the factors of CI in PSE patients.

RESULTS

In total, CI was present in 81 (69%) and absent in 36 (31%) PSE patients. MoCA total score in the PSE+CI group was 20.85±4.13 and 27.53±1.34 in the PSECI group. The Bonferroni corrected significance level was 0.0013. Scores for multiple cognitive domains (visuospatial/executive skills, naming, attention, language and delayed recall) were lower in the PSE+CI group than the PSE-CI group. Moreover, the PSE+CI group had a higher incidence of depression and anxiety. Univariate analysis showed that diabetes (p= 0.000) and the number of antiepileptic drugs (AEDs) (p= 0.001) were associated with CI in PSE. Binary logistic regression analysis showed that diabetes (odds ratio [OR]: 5.242, 95% confidence interval [CI]: 1.680-16.363, p= 0.004), high homocysteine levels (OR: 1.103, 95% CI: 1.008-1.207, p= 0.033) and the number of AEDs (OR: 3.354, 95% CI: 1.225-9.180, p= 0.019) were associated with CI in PSE.

SIGNIFICANCE

Diabetes, high homocysteine levels and a higher number of AEDs may be risk factors for CI in PSE.