%0 Journal Article
%T The impact of early
%A Fergus N Doubal
%A Francesca M Chappell
%A Joanna M Wardlaw
%A Julie Staals
%A Kirsten Shuler
%A Martin S Dennis
%A Stephen DJ Makin
%J European Stroke Journal
%@ 2396-9881
%D 2018
%R 10.1177/2396987317750517
%X Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1每3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke＊s Cognitive Examination每Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56每74) years, 36/157 (23%) patients had a Addenbrooke＊s Cognitive Examination每Revised scoreˋ<ˋ82 at one to three months, 29/151 (19%) had a Addenbrooke＊s Cognitive Examination每Revisedˋ<ˋ82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). 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. Pre-morbid intelligence should be considered in future studies of post-stroke cognition
%K Stroke
%K post-stroke dementia
%K intelligence quotient
%K National Adult Reading Test
%K lacunar stroke
%U https://journals.sagepub.com/doi/full/10.1177/2396987317750517