Abstract
Cognitive dysfunction is an important consequence of ischemic stroke, which can progress in the first few years and is primarily determined by clinical factors. This study aimed to investigate the clinical determinants of cognitive dysfunction in stroke survivors in West Nusa Tenggara Province, Indonesia. This cross-sectional study assessed 255 ischemic stroke survivors with a mean age of 57.1±9.3 years old and 29–79 years old, recruited consecutively in three main hospitals in West Nusa Tenggara Province between March 2019 and October 2021. Categorical data collected included age, sex, education level, clinical determinants of ischemic stroke, and cognitive status of the patients. The association between the clinical determinants of ischemic stroke and the risk of cognitive dysfunction in patients was analyzed using logistic regression after adjusting for age, sex, and level of education. The final multiple logistic regression analysis models revealed infarct diameter as the only clinical determinant significantly associated with an increased risk of cognitive dysfunction (OR = 3.14;95% CI = 1.20–8.23). Thus, a larger infarct diameter is the only clinical determinant of cognitive dysfunction in ischemic stroke survivors in West Nusa Tenggara Province, Indonesia.
References
1. Aam S, Einstad MS, Munthe-Kaas R, Lydersen S, Ihle-Hansen H, Knapskog AB, et al. Post-stroke cognitive impairment - impact of follow-up time and stroke subtype on severity and cognitive profile: The Nor-COAST study. Frontiers in Neurology. 2020; 11: 699.
2. Sun J-H, Tan L, Yu J-T. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Annals of Translational Medicine. 2014; 2 (8): 80.
3. Harahap HS, Akbar M, Tammasse J, Bintang AK, Zainuddin AA. Characteristics of cognitive status in sub-population of sub-acute stage of ischemic stroke patients in west Nusa Tenggara, Indonesia. Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal). 2021; 16 (3): 171–7.
4. Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019; 93 (24): e2257-71.
5. Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S, Mohamad K. Cognitive impairment and memory dysfunction after a stroke diagnosis: a poststroke memory assessment. Neuropsychiatric Disease and Treatment. 2014; 10: 1677–91.
6. Li J, Wang J, Wu B, Xu H, Wu X, Zhou L, et al. Association between early cognitive impairment and midterm functional outcomes among Chinese acute ischemic stroke patients: a longitudinal study. Frontiers in Neurology. 2020; 11: 20.
7. Aam S, Gynnild MN, Munthe-Kaas R, Saltvedt I, Lydersen S, Knapskog AB, et al. The impact of vascular risk factors on post-stroke cognitive impairment: the Nor-COAST study. Frontiers in Neurology. 2021; 12: 678794.
8. Wang Y, Liu G, Hong D, Chen F, Ji X, Cao G. White matter injury in ischemic stroke. Progress in Neurobiology. 2016; 141: 45–60.
9. Desai SM, Rocha M, Jovin TG, Jadhav AP. High variability in neuronal loss. Stroke. 2019 ;50 (1): 34–7.
10. Veldsman M, Werden E, Egorova N, Khlif MS, Brodtmann A. Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke. Scientific Reports. 2020; 10: 17911.
11. Etherton MR, Rost NS, Wu O. Infarct topography and functional outcomes. Journal of Cerebral Blood Flow and Metabolism. 2018; 38 (9): 1517–32.
12. Smith AG, Hill CR. Imaging assessment of acute ischaemic stroke: a review of radiological methods. The British Journal of Radiology. 2018; 91 (1083): 20170573.
13. Ganguli M, Fu B, Snitz BE, Unverzagt FW, Loewenstein DA, Hughes TF, et al. Vascular risk factors and cognitive decline in a population sample. Alzheimer Disease and Associated Disorders. 2014; 28 (1): 9– 15.
14. Iadecola C. The pathobiology of vascular dementia. Neuron. 2013; 80 (4): 844–66.
15. Viswanathan A, Macklin EA, Betensky R, Hyman B, Smith eric E, Blacker D. The influence of vascular risk factors and stroke on cognition in late-life: analysis of the NACC cohort. Alzheimer Disease and Associated Disorders. 2015; 29 (4): 287–93.
16. Iadecola C, Gottesman RF. Neurovascular and cognitive dysfunction in hypertension: epidemiology, pathobiology, and treatment. CircResearch. 2019; 124 (7): 1025–44.
17. Stanciu GD, Bild V, Ababei DC, Rusu RN, Cobzaru A, Paduraru L, et al. Link between diabetes and Alzheimer's disease due to the shared amyloid aggregation and deposition involving both neurodegenerative changes and neurovascular damages. Journal of Clinical Medicine. 2020; 9: 1713.
18. Faruk FM. Regional social sustainability index in Indonesia 2017. Jurnal Perencanaan Pembangunan: The Indonesian Journal of Development Planning. 2017; 4 (1): 40–53.
19. Lv P, Jin H, Liu Y, Cui W, Peng Q, Liu R, et al. Comparison of risk factor between lacunar stroke and large artery atherosclerosis stroke: a cross-sectional study in China. PLoS One. 2016; 11 (3): e0149605.
20. Lin CF, Chang YH, Chien SC, Lin YH, Yeh HY. Epidemiology of dyslipidemia in the Asia Pacific region. International Journal of Gerontology. 2018; 12 (1): 2–6.
21. Rambe AS, Fitri FI. Correlation between the Montreal cognitive assessment- Indonesian version ( Moca-INA ) and the Mini-mental state examination ( MMSE ) in elderly. Open Access Macedonian Journal of Medical Sciences. 2017; 5 (7): 915–9.
22. Prodjohardjono A, Vidyanti AN, Sudarmanta, Sutarni S, Setyopranoto I. Higher level of acute serum VEGF and larger infarct volume are more frequently associated with post-stroke cognitive impairment. PLoS One. 2020; 15 (10): e0239370.
23. Terasaki Y, Liu Y, Hayakawa K, D PL, Lo EH, Ji X, et al. Mechanisms of neurovascular dysfunction in acute ischemic brain. Current Medicinal Chemistry. 2014;
21 (18): 2035–42. 24. Joubert J, Prentice LF, Moulin T, Liaw ST, Joubert LB, Preux PM, et al. Stroke in rural areas and small communities. Stroke. 2008; 39: 1920–8.
25. Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in South, East, and South-East Asia: a review. Journal of Stroke. 2017; 19 (3): 286–94.
26. Dacosta-Aguayo R, Grana M, Fernandez-Andujar M, Lopez-Cancio E, Caceres C, Bargallo N, et al. Structural integrity of the contralesional hemisphere predicts cognitive impairment in ischemic stroke at three months. PLoS One. 2014; 9 (1): e86119.
27. Douiri A, Rudd AG, Wolfe CDA. Prevalence of poststroke cognitive impairment: South London stroke register 1995-2010. Stroke. 2013; 44 (1): 138–45.
28. Melkas S, Jokinen H, Hietanen M, Erkinjuntti T. Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment. Degenerative Neurological and Neuromuscular Disease. 2014; 4: 21– 7.
29. Zulkifly MFM, Ghazali SE, Din NC, Singh DKA, Subramaniam P. A review of risk factors for cognitive impairment in stroke survivors. The Scientific World Journal. 2016; 2016: 3456943.
30. Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochimica et Biophysica Acta - Molecular Basis of Disease. 2016; 1862 (5): 915–25.
Recommended Citation
Harahap HS , Putri SA , Indrayana Y ,
et al.
Infarct Diameter for Predicting Cognitive Dysfunction in Ischemic Stroke Survivors in West Nusa Tenggara, Indonesia.
Kesmas.
2022;
17(2):
113-119
DOI: 10.21109/kesmas.v17i2.5688
Available at:
https://scholarhub.ui.ac.id/kesmas/vol17/iss2/5
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