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NEUROLOGY 2005;64:821-827
© 2005 American Academy of Neurology

The prognostic value of domain-specific cognitive abilities in acute first-ever stroke

G. M.S. Nys, MSc, M. J.E. van Zandvoort, PhD, P. L.M. de Kort, MD, PhD, H. B. van der Worp, MD, PhD, B. P.W. Jansen, MD, A. Algra, MD, PhD, E. H.F. de Haan, PhD and L. J. Kappelle, MD, PhD

From Psychological Laboratory (G.M.S. Nys, and Drs. van Zandvoort and de Haan), Helmholtz Institute, Utrecht University; Department of Neurology (G.M.S. Nys, and Drs. van Zandvoort, van der Worp, Algra, de Haan, and Kappelle) and Julius Center for Health Sciences and Primary Care (Dr. Algra), University Medical Center Utrecht; and Department of Neurology (Drs. de Kort and Jansen), St. Elisabeth & Tweesteden Hospital Tilburg, the Netherlands.

Address correspondence and reprint requests to Dr. G.M.S. Nys, Psychological Laboratory, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands; e-mail: g.nys{at}fss.uu.nl

Objective: To evaluate the prognostic value of domain-specific cognitive abilities in acute stroke with respect to long-term cognitive and functional outcome in addition to neurologic and demographic predictors.

Methods: The authors evaluated 168 patients within the first 3 weeks after first-ever stroke. The prevalence of neuropsychological impairment was calculated vs 75 matched healthy controls. The authors also recorded demographic data, vascular risk factors, lesion characteristics, and clinical factors at admission. Independent predictor variables associated with long-term cognitive impairment (assessed with a follow-up neuropsychological examination) and functional impairment (assessed with the modified Barthel Index and the Frenchay Activities Index) were identified with stepwise multiple logistic regression. Areas under receiver operator characteristic curves were used to compare the predictive value of three models, i.e., a standard medical model, a purely cognitive model, and a model consisting of both medical and cognitive predictors.

Results: Thirty-one percent of patients showed long-term cognitive impairment. Basic and instrumental ADL disturbances remained present in 19% and 24% of patients. Domain-specific cognitive functioning predicted cognitive and functional outcome better than any other variable. Moreover, the prediction of instrumental ADL functioning improved when cognitive predictors were added to the standard medical model (p < 0.05). Impairments in abstract reasoning and executive functioning were independent predictors of long-term cognitive impairment. Inattention and perceptual disorders were more important in predicting long-term functional impairment.

Conclusion: Domain-specific cognitive abilities in the early phase of stroke are excellent independent predictors of long-term cognitive and functional outcome.




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