Projects per year
Background: Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods: We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, MRI-detected stroke sub-type and small vessel disease burden. At 1-3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke's Cognitive Examination Revised, ACE-R), pre-morbid intelligence (National Adult Reading Test , NART) and dependency (modified Rankin Scale, mRS). Results: We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56-74) years, 36/157 (23%) patients had an ACE-R score <82 at 1-3 months, 29/151 (19%) had an ACE-R <82 at 1 year. Lower NART score (cognitive impairment per point on NART OR 0.91, 95% CI 0.87,0.95) and older age (per year of age OR 1.04 (95% CI 1.01,1.08) predicted 1 year cognitive impairment more than stroke severity (per point on NIHSS OR 0.96 (95% CI 0.0.68,1.31)) or vascular risk factors e.g. hypertension (OR for diagnosis of hypertension 0.52 (95% CI 0.24,1.15). Cognitive impairment was associated with having more white matter hyper-intensities (OR per point increase in Fazekas Score 1.42, 95% CI 1.11,1.83) Discussion: This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion: Pre-morbid intelligence should be considered in future studies of post-stroke cognition.
1/01/17 → 31/12/21
Senior Clinical Lectureship: A platform for patient focused trials to prevent cerebral small vessel disease
1/06/15 → 31/05/21