There may be an association between pre-stroke cognitive performance and mortality in patients following the first occurrence of stroke or transient ischemic attack, (TIA), a recent study says. Researchers report that the 14-year study encompassed a community-based sample of 919 men aged 70 years old and enabled researchers to follow-up with the patients via registry data from the Swedish National Board of Health and Welfare and discharge records.

According to researchers, participants engaged in the Trail Making Test (TMT), a cognitive test that consists of digits (TMT-A) and digits and letters (TMT-B). In the TMT-A, participants were asked to use a pencil to draw lines as quickly as possible between numbers in ascending order. The study notes that in the TMT-B, letters were also added, requiring participants to alternate between letters and numbers in ascending order. Researchers add that the score was equal to the time taken to complete the test, in seconds. The maximum time for the TMT-B was 240 seconds, with 41 participants reaching the maximum time allotted. The study indicates that a longer completion time reflects impaired psychomotor speed.

The Mini-Mental State Examination (MMSE) was also used in the study, researchers say. The results suggest that 54% of first-ever stroke/TIA patients expired under a median follow-up of 2 ½ years following the event.  According to Cox proportional hazard analyses adjusted for age, education, social group, and traditional stroke risk factors, poor performance in TMT-A was strongly associated with mortality. Researchers add that mortality risk was approximately threefold in the highest tertile compared to the lower tertile. The results also indicate a similar pattern in TMT-B, however, the results of the MMSE were not related to risk of post-stroke mortality.

Researchers conclude that performance pre-stroke measured with TMT-A and –B strongly predicts mortality after stroke. 

Source: BMJ Open