Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia.
Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
PLoS One. 2024 Aug 30;19(8):e0308103. doi: 10.1371/journal.pone.0308103. eCollection 2024.
Mild stroke affects more than half the stroke population, yet there is limited evidence characterizing cognition over time in this population, especially with predictive approaches applicable at the individual-level. We aimed to identify patterns of recovery and the best combination of demographic, clinical, and lifestyle factors predicting individual-level cognitive state at 3- and 12-months after mild stroke.
In this prospective cohort study, the Montreal Cognitive Assessment (MoCA) was administered at 3-7 days, 3- and 12-months post-stroke. Raw changes in MoCA and impairment rates (defined as MoCA<24 points) were compared between assessment time-points. Trajectory clusters were identified using variations of ≥1 point in MoCA scores. To further compare clusters, additional assessments administered at 3- and 12-months were included. Gamma and Quantile mixed-effects regression were used to predict individual MoCA scores over time, using baseline clinical and demographic variables. Model predictions were fitted for each stroke survivor and evaluated using model cross-validation to identify the overall best predictors of cognitive recovery.
Participants' (n = 119) MoCA scores improved from baseline to 3-months (p<0.001); and decreased from 3- to 12-months post-stroke (p = 0.010). Cognitive impairment rates decreased significantly from baseline to 3-months (p<0.001), but not between 3- and 12-months (p = 0.168). Nine distinct trajectory clusters were identified. Clinical characteristics between clusters at each time-point varied in cognitive outcomes but not in clinical and/or activity participation outcomes. Cognitive performance at 3- and 12-months was best predicted by younger age, higher physical activity levels, and left-hemisphere lesion side.
More than half of mild-stroke survivors are at risk of cognitive decline one year after stroke, even when preceded by a significantly improving pattern in the first 3-months of recovery. Physical activity was the only modifiable factor independently associated with cognitive recovery. Individual-level prediction methods may inform the timing and personalized application of future interventions to maximize cognitive recovery post-stroke.
轻度中风影响了超过一半的中风患者，但目前针对该人群的认知功能随时间变化的特征描述证据有限，尤其是缺乏适用于个体水平的预测方法。我们旨在确定恢复模式，并确定最佳的人口统计学、临床和生活方式因素组合，以预测轻度中风后 3 个月和 12 个月的个体认知状态。
在这项前瞻性队列研究中，在中风后 3-7 天、3 个月和 12 个月时进行蒙特利尔认知评估（MoCA）。比较了各评估时间点间 MoCA 的变化和损伤率（定义为 MoCA<24 分）。使用 MoCA 评分变化≥1 点来确定轨迹聚类。为了进一步比较聚类，还纳入了在 3 个月和 12 个月时进行的额外评估。使用伽马和分位数混合效应回归，基于基线临床和人口统计学变量，预测个体的 MoCA 评分随时间的变化。为每位中风幸存者拟合模型预测，并使用模型交叉验证评估，以确定认知恢复的最佳整体预测因子。
参与者（n=119）的 MoCA 评分从基线到 3 个月时提高（p<0.001）；从 3 个月到 12 个月时降低（p=0.010）。认知损伤率从基线到 3 个月时显著降低（p<0.001），但在 3 个月到 12 个月时没有降低（p=0.168）。确定了 9 个不同的轨迹聚类。各时间点的聚类间的临床特征在认知结局方面存在差异，但在临床和/或活动参与结局方面没有差异。3 个月和 12 个月时的认知表现，最好由年龄较小、较高的身体活动水平和左侧半球病变侧来预测。
即使在恢复的前 3 个月内认知功能显著改善，超过一半的轻度中风幸存者在中风后 1 年仍有认知能力下降的风险。身体活动是唯一与认知恢复独立相关的可改变因素。个体水平的预测方法可能为未来干预措施的时机和个性化应用提供信息，以最大限度地提高中风后的认知恢复。
