Cognitive impairment in lacunar strokes: The SPS3 trial
Version of Record online: 2 OCT 2012
Copyright © 2012 American Neurological Association
Annals of Neurology
Volume 72, Issue 3, pages 351–362, September 2012
How to Cite
Jacova, C., Pearce, L. A., Costello, R., McClure, L. A., Holliday, S. L., Hart, R. G. and Benavente, O. R. (2012), Cognitive impairment in lacunar strokes: The SPS3 trial. Ann Neurol., 72: 351–362. doi: 10.1002/ana.23733
- Issue online: 2 OCT 2012
- Version of Record online: 2 OCT 2012
- Accepted manuscript online: 18 AUG 2012 04:19AM EST
- Manuscript Accepted: 27 JUL 2012
- Manuscript Revised: 24 JUL 2012
- Manuscript Received: 16 APR 2012
Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients.
All English-speaking participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (National Clinical Trial 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z scores using published norms. Those with impairment (z ≤ −1.5) in memory and/or nonmemory domains were classified as having mild cognitive impairment (MCI).
Among the 1,636 participants, average z scores on all tests were <0, with the largest deficits seen on tests of episodic memory (range of means, −0.65 to −0.92), verbal fluency (mean, −0.89), and motor dexterity (mean, −2.5). Forty-seven percent were classified as having MCI (36% amnestic, 37% amnestic multidomain, 28% nonamnestic). Of those with modified Rankin score 0–1 and Barthel score = 100, 41% had MCI. Younger age (odds ratio [OR] per 10-year increase, 0.87), male sex (OR, 1.3), less education (OR, 0.13–0.66 for higher education levels compared to 0–4 years education), poststroke disability (OR, 1.4), and impaired activities of daily living (OR, 1.8) were independently associated with MCI.
In this large, well-characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae. ANN NEUROL 2012;72:351–362