Cognitive trajectory in the first year after first-ever ischaemic stroke in young adults: the ODYSSEY study

Mijntje M I Schellekens; Ravi C S Springer; Esther M Boot; Jamie I Verhoeven; Merel S Ekker; Mayte E van Alebeek; Paul J A M Brouwers; Renate M Arntz; Gert W van Dijk; Rob A R Gons; Inge W M van Uden; Tom den Heijer; Julia H van Tuijl; Karlijn F de Laat; Anouk G W van Norden; Sarah E Vermeer; Marian S G van Zagten; Robert J Van Oostenbrugge; Marieke J H Wermer; Paul J Nederkoorn; Frank G van Rooij; Ido R van den Wijngaard; Paul L M de Kort; Frank-Erik De Leeuw; Roy P C Kessels; Anil M Tuladhar

doi:10.1136/jnnp-2023-332104

Cognitive trajectory in the first year after first-ever ischaemic stroke in young adults: the ODYSSEY study

J Neurol Neurosurg Psychiatry. 2023 Dec 30:jnnp-2023-332104. doi: 10.1136/jnnp-2023-332104. Online ahead of print.

Authors

Mijntje M I Schellekens^{1

2}, Ravi C S Springer¹, Esther M Boot^{1

2}, Jamie I Verhoeven^{1

2}, Merel S Ekker^{1

2}, Mayte E van Alebeek³, Paul J A M Brouwers⁴, Renate M Arntz⁴, Gert W van Dijk⁵, Rob A R Gons⁶, Inge W M van Uden⁶, Tom den Heijer⁷, Julia H van Tuijl⁸, Karlijn F de Laat⁹, Anouk G W van Norden¹⁰, Sarah E Vermeer¹¹, Marian S G van Zagten¹², Robert J Van Oostenbrugge^{13

14}, Marieke J H Wermer^{15

16}, Paul J Nederkoorn¹⁷, Frank G van Rooij¹⁸, Ido R van den Wijngaard¹⁹, Paul L M de Kort⁸, Frank-Erik De Leeuw^{1

2}, Roy P C Kessels^{2

20

21}, Anil M Tuladhar^{22

2}

Affiliations

¹ Neurology, Radboudumc, Nijmegen, The Netherlands.
² Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands.
³ Neurology, Gelre Hospitals, Zutphen, The Netherlands.
⁴ Neurology, Medisch Spectrum Twente, Enschede, The Netherlands.
⁵ Neurology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
⁶ Neurology, Catharina Hospital, Eindhoven, The Netherlands.
⁷ Neurology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
⁸ Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
⁹ Neurology, Haga Hospital, Den Haag, The Netherlands.
¹⁰ Neurology, Amphia Hospital, Breda, The Netherlands.
¹¹ Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
¹² Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
¹³ Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁴ University Maastricht School for Mental Health and Neuroscience, Maastricht, The Netherlands.
¹⁵ Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
¹⁶ Neurology, University Medical Centre Groningen, Groningen, The Netherlands.
¹⁷ Neurology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands.
¹⁸ Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
¹⁹ Department of Neurology, Medical Centre Haaglanden, Den Haag, The Netherlands.
²⁰ Vincent Van Gogh Instituut for Psychiatry, Venray, The Netherlands.
²¹ Department of Medical Psychology and Radboudumc Alzheimer Center, Radboudumc, Nijmegen, The Netherlands.
²² Neurology, Radboudumc, Nijmegen, The Netherlands Anil.Tuladhar@radboudumc.nl.

PMID: 38160045
DOI: 10.1136/jnnp-2023-332104

Abstract

Background: Limited data exists on cognitive recovery in young stroke patients. We aimed to investigate the longitudinal course of cognitive performance during the first year after stroke at young age and identify predictors for cognitive recovery.

Methods: We conducted a multicentre prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischaemic stroke. Cognitive assessments were performed within 6 months and after 1 year following the index event, covering seven cognitive domains. Composite Z-scores using normative data determined cognitive impairment (Z-score<-1.5). A Reliable Change Index (RCI) assessed cognitive recovery (RCI>1.96) or decline (RCI<-1.96).

Results: 393 patients (median age 44.3 years, IQR 38.4-47.2) completed cognitive assessments with a median time interval of 403 days (IQR 364-474) between assessments. Based on RCI, a similar proportion of patients showed improvement and decline in each cognitive domain, while the majority exhibited no cognitive change. Among cognitively impaired patients at baseline, improvements were observed in processing speed (23.1%), visuoconstruction (40.1%) and executive functioning (20.0%). Younger age was associated with better cognitive recovery in visuoconstruction, and larger lesion volume was related to cognitive recovery in processing speed. No other predictors for cognitive recovery were identified.

Conclusions: Cognitive impairment remains prevalent in young stroke even 1 year after the event. Most patients showed no cognitive change, however, recovery may have occurred in the early weeks after stroke, which was not assessed in our study. Among initially cognitively impaired patients, cognitive recovery is observed in processing speed, visuoconstruction and executive functioning. It is still not possible to predict cognitive recovery in individual patients.

Keywords: COGNITION; STROKE.