Background and purpose

Post-stroke cognitive impairment is a common and well-known consequence of supra-tentorial infarct, but its prevalence and severity after infra-tentorial infarct is unclear. We compared the frequencies and prognostic value of domain-specific cognitive deficits after supra-tentorial and infra-tentorial infarct.

Methods

In a consecutive cohort of patients with first-ever stroke (N = 244) admitted to Helsinki University Hospital, 37 patients had an infra-tentorial infarct. Patients were assessed with a comprehensive neuropsychological examination 3 months post-stroke covering 9 cognitive domains and functional disability was assessed at 15 months with the modified Rankin Scale.

Results

There were no statistically significant differences between the frequencies of cognitive deficits in patients with infra-tentorial vs supra-tentorial infarct. Altogether 73% of patients with infra-tentorial infarct and 82% of patients with supra-tentorial infarct had impairment in at least one cognitive domain. Further 42% of patients with infra-tentorial infarct and 47% of those with supra-tentorial infarct had deficits in 3 or more cognitive domains. In patients with infra-tentorial infarct, visuo-constructional deficits were significantly associated with functional disability at 15 months (OR 9.0, 95%CI 1.3–62.5, p = 0.027). In patients with supratentorial infarct, executive deficits (OR 2.9, 95%CI 1.5–5.8, p = 0.002) and visuo-constructional deficits (OR 2.9, 95%CI 1.5–5.7, p = 0.001) showed associations with functional disability at 15 months.

Conclusion

Cognitive deficits are as common in patients with infra-tentorial infarct as in those with supra-tentorial infarct, and it is important to recognize them to meet the needs of rehabilitation.

中文翻译：

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脑幕下梗死后经常发生卒中后认知障碍

背景和目的

卒中后认知障碍是幕上梗死常见且众所周知的后果，但其在幕下梗死后的患病率和严重程度尚不清楚。我们比较了幕上和幕下梗死后特定领域认知缺陷的频率和预后价值。

方法

在赫尔辛基大学医院收治的首次中风患者（N = 244）的连续队列中，37 名患者出现幕下梗死。中风后 3 个月对患者进行全面的神经心理学检查，涵盖 9 个认知领域，并在 15 个月时使用改良的 Rankin 量表对功能障碍进行评估。

结果

幕下梗死与幕上梗死患者的认知缺陷频率之间没有统计学上的显着差异。总共有 73% 的幕下梗死患者和 82% 的幕上梗死患者在至少一个认知领域有障碍。此外，42% 的幕下梗死患者和 47% 的幕上梗死患者在 3 个或更多认知领域存在缺陷。在幕下梗死患者中，视觉结构缺陷与 15 个月时的功能障碍显着相关（OR 9.0，95%CI 1.3-62.5，p  = 0.027）。在幕上梗死患者中，执行缺陷（OR 2.9, 95%CI 1.5–5.8, p  = 0.002）和视觉结构缺陷（OR 2.9, 95%CI 1.5–5.7,p  = 0.001) 显示与 15 个月时的功能障碍相关。

结论

认知缺陷在幕下梗死患者和幕上梗死患者中一样常见，识别它们以满足康复需求很重要。