Prestroke Cognitive Impairment: Examining the Impact of Premorbid Neuropsychiatric Symptoms and Functional Limitations on Stroke Outcomes
Alaaeldin Esmail1, Mahmoud Elsayed1, Mohamed Abouzaid1, Mohamed Abouelseoud1, Nada Y. Hegazy1
1MME Foundation
Objective:
The objective of this study is to investigate the relationship between prestroke cognitive impairment and premorbid neuropsychiatric symptoms and functional limitations, aiming to determine how these factors influence stroke outcomes and recovery in patients.
Background:
Prestroke cognitive impairment plays a critical role in influencing treatment outcomes and recovery in stroke patients. This study explores the relationship between prestroke cognitive status, neuropsychiatric symptoms, and functional limitations, aiming to inform more tailored interventions.
Design/Methods:
We conducted a cross-sectional analysis of 520 stroke patients hospitalized in a neurology unit. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was used to assess cognitive status prior to stroke onset. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory Questionnaire (NPI-Q), and functional abilities were evaluated through Activities of Daily Living (ADL) and the Clinical Dementia Rating (CDR) scale.
Results:
Our findings revealed that 32.5% of patients exhibited cognitive impairment before experiencing a stroke. This cognitive decline was significantly associated with an increase in neuropsychiatric symptoms (NPI-Q score: 5.5 ± 4.9 vs. 1.7 ± 2.3, p < 0.001) and greater functional limitations (ADL score: 1.8 ± 1.9 vs. 0.3 ± 0.8, p < 0.001). Further analysis through logistic regression identified older age, the presence of white matter lesions (OR: 1.26, 95% CI: 1.003-1.58), and medial temporal lobe atrophy (OR: 3.97, 95% CI: 1.62-9.73) as significant predictors of cognitive impairment.
Conclusions:
The study underscores the prevalence of cognitive impairment before a stroke and its substantial impact on neuropsychiatric and functional outcomes post-stroke. These findings highlight the necessity of early cognitive evaluations in stroke care, suggesting that addressing cognitive decline prior to a stroke could improve patient outcomes through more personalized and timely interventions.
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