22. European Stroke Conference 411 Behavioral disorders and post-stroke dementia Cognitive Impairment after Lacunar Stroke S.D.J. Makin1, M.S. Dennis2, J.M. Wardlaw3 University of Edinburgh, Edinburgh, UNITED KINGDOM1, University of Edinburgh, Edin-burgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3 Background: Lacunar stroke may carry a greater risk of cognitive impairment than other stroke sub-types by association with cerebral small vessel disease (SVD), or the risk may be lower as the infarct is small. Our recent systematic review found 19 studies which compared lacunar to non-lacu-nar stroke, but none accounted for SVD, depression or pre-morbid IQ. We compared cognition in la-cunar stroke and mild cortical stroke, whilst correcting for age, SVD, depression and pre-morbid IQ. Methods: We recruited inpatients and outpatients with a non-disabling ischaemic stroke diagnosed by DWI-MRI. We excluded patients who were unable to consent, or were not likely to be well enough for follow-up. We assessed white matter hyperintensities (WMH) using the Fazekas scale and cognition using the Addenbrookes Cognitive Assessment (ACE-R), and the National Adult Reading Test (NART) for pre-morbid intelligence and the Beck Depression Index. We defined ‘de-mentia’ as an ACE-R<88. Results: We recruited 157 patients at median 45 days (IQR 36-65 days) after a stroke (median age 66, median NIHSS 2): 22/69 (31%) with lacunar and 33/88 (37%) with cortical stroke had demen-tia. One third (18/55) of patients with dementia were aged <65 years. Adjusted Odds Ratio (OR) for cognitive impairment after lacunar versus cortical stroke was 0.57 (95% CI 0.23-1.43). Risk of dementia increased with age and stroke severity and lower pre-stroke IQ (NART) adjusted for age, stroke severity, WMH, and depression. There was no association with lesion location, alcohol use, WMH score, or other co-morbidities. Discussion: A third of patients with lacunar stroke, 1/3rd being of working age, had dementia at 6 weeks after lacunar stroke, similar to those with mild cortical stroke: advancing age and stroke se-verity were the strongest predictors; higher pre-morbid IQ was protective. Studies of cognition after stroke should assess premorbid IQ. Long term follow-up is ongoing. 504 © 2013 S. Karger AG, Basel Scientific Programme 412 Behavioral disorders and post-stroke dementia Poststroke depression and depression-executive dysfunction syndrome predict recurrence of ischemic stroke G. Sibolt1, S. Curtze2, S. Melkas3, T. Pohjasvaara4, M. Kaste5, P. Karhunen6, N.K.J. Oksala7, R. Vataja8, T. Erkinjuntti9 Department of Neurology, Helsinki University Central Hospital and Department of Neurolog-ical Sciences, University of Helsinki, Helsinki, FINLAND1, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Hel-sinki, FINLAND2, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, FINLAND3, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Hel-sinki, Helsinki, FINLAND4, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, FINLAND5, School of Med-icine, Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, FINLAND6, Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, FINLAND7, Kellokoski Hospital, Kellokoski, FINLAND8, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, FINLAND9 Background: The objective of this study was to investigate whether patients with poststroke depres-sion or depression-executive dysfunction syndrome have increased rates of stroke recurrence. Methods: We included 223 consecutive patients with ischemic stroke admitted to Helsinki Universi-ty Central Hospital with a follow-up of 12 years. National register data was reviewed for all diagno-sis codes of ischemic stroke, survival data and causes of death. Univariate analysis was performed using Chi-square, Mantel-Haenszel, ANOVA, and Kaplan- Mei-er log rank analysis. A Cox multivariable model with forced entry was used to adjust for stroke risk-factors as age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial dis-ease, and hypercholesterolaemia. Results: Compared to other patients, the mean time to first recurrent stroke was shorter for depressed patients (8.15; 95% CI 7.11-9.19 versus 9.63; 8.89-10.38 years) and even shorter for patients with depression-executive dysfunction syndrome (7.15; 5.55-8.75 versus 9.75; 9.09-10.41 years). During 12 years follow up the cumulative risk for recurrent ischemic stroke in was higher in the depression group (Log Rank p=0.04) and in the depression-executive dysfunction syndrome group (Log Rank p=0.01) compared to other patients. Independent predictors of recurrent stroke in the Cox multivariable analyses were increasing age (1.05; 1.01-1.08 / year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and depression-executive dysfunction syndrome (1.95; 1.14-3.33). Conclusions: Depression and even more depression-executive dysfunction syndrome predict the re-currence of ischemic stroke. Executive dysfunction without depression is not a predictor of stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of sec-ondary prevention in patients with ischemic stroke.
Karger_ESC London_2013
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