Incidence and Factors Associated With Cognitive Impairment 90 Days After First Ever Ischemic Stroke

Int J Geriatr Psychiatry. 2025 May;40(5):e70087. doi: 10.1002/gps.70087.

ABSTRACT

OBJECTIVES: Post-stroke cognitive impairment (PSCI) is prevalent among stroke survivors, negatively impacting long-term outcomes. We aimed to assess the prevalence of PSCI and its risk factors in participants from the iBioStroke study (n = 1042), 90 days after their first ischemic stroke.

METHODS: We prospectively analyzed data from 582 participants, without cognitive problems before stroke based on the structured interview with the patient, a family member or a caregiver, and/or clinical documentation (if available), who completed the Montreal Cognitive Assessment (MoCA) at discharge and 90 days post-stroke. Two MoCA cut-offs were used to define PSCI: a score of ≤ 25 in the first model and ≤ 22 in the second model. Multivariate logistic regression was employed to identify independent risk factors for PSCI based on 30 collected parameters.

RESULTS: In the first model, PSCI was identified in 418 (71.8%) participants at day 90. Independent risk factors included older age (OR = 1.05; 95% CI:1.02-1.08), fewer years of education (OR = 0.83; 95% CI: 0.73-0.93), lower MoCA scores at discharge (OR = 0.76; 95% CI: 0.69-0.84), higher anxiety levels (HADS-A) at day 90 (OR = 1.10; 95% CI: 1.01-1.21), and larger stroke volume (OR = 1.01; 95% CI: 1.00-1.01). In the second model, PSCI was observed in 294 (50.5%) participants. Older age (OR = 1.06; 95% CI: 1.03-1.09), fewer years of education (OR = 0.87; 95% CI: 0.78-0.96), lower MoCA scores at discharge (OR = 0.83; 95% CI: 0.77-0.88), and higher depression levels (HADS-D) at day 90 (OR = 1.10; 95% CI: 1.03-1.18) were significant predictors.

CONCLUSIONS: Based on our data, PSCI seems to be a common consequence of stroke. Both irreversible factors, such as age and educational level, stroke volume, and potentially modifiable factors, including post-stroke anxiety or depression and acute cognitive impairment, contribute to PSCI risk. These findings underscore the importance of early cognitive and psychiatric interventions in stroke survivors.

PMID:40286199 | DOI:10.1002/gps.70087