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Table 4 Factors affecting cognitive change from 3 months to 12 months in older patients

From: Factors associated with improvement or decline in cognitive function after an ischemic stroke in Korea: the Korean stroke cohort for functioning and rehabilitation (KOSCO) study

Parameters Normal Cognition (n = 835) Declined Cognition (n = 596)
  Stable (n = 612) Converter (n = 79) Reverter (n = 144) P value Stable (n = 336) Converter (n = 183) Reverter (n = 77) P value
1) Baseline medical record assessments
Male, n (%) 375 (61.3) 37 (46.8) 66 (45.8) .000** 163 (48.5) 91 (49.7) 38 (49.4) .963
Age, (mean ± SD) 73.15 ± 5.86 a 75.24 ± 6.84 b 76.53 ± 6.21 b .000** 76.06 ± 6.15 74.78 ± 5.55 75.95 ± 6.09 .059
Education, n (%)
 Uneducated 98 (16.0) 24 (30.4) 41 (28.5) .000** 33 (9.8) 10 (5.5) 12 (15.6) .307
 0–3 years 34 (5.6) 9 (11.4) 10 (6.9)   36 (10.7) 20 (10.9) 9 (11.7)  
 4–6 years 132 (21.6) 22 (27.8) 43 (29.9)   106 (31.5) 61 (33.3) 23 (29.9)  
 7 - 9 years 103 (16.8) 12 (15.2) 25 (17.4)   74 (22.0) 35 (19.1) 17 (22.1)  
 10 - 12 years 142 (23.2) 4 (5.1) 15 (10.4)   71 (21.1) 41 (22.4) 13 (16.9)  
 13 years - 103 (16.8) 8 (10.1) 10 (6.9)   16 (4.8) 16 (8.7) 3 (3.9)  
BMI (kg/m2), (mean ± SD) 23.72 ± 3.20 23.59 ± 3.61 23.11 ± 3.43 .115 23.00 ± 2.96 23.24 ± 3.15 22.26 ± 3.23 .066
Risk factors of stroke, n (%)
 Hypertension 414 (67.6) 54 (68.4) 91 (63.2) .570 212 (63.1) 116 (63.4) 55 (71.4) .371
 Diabetes Mellitus 102 (16.7) 12 (15.2) 15 (10.4) .175 55 (16.4) 28 (15.3) 17 (22.1) .392
 Coronary heart disease 60 (9.8) 8 (10.1) 11 (7.6) .711 27 (8.0) 16 (8.7) 5 (6.5) .831
 Atrial fibrillation 78 (12.7) 11 (13.9) 22 (15.3) .712 59 (17.6) 27 (14.8) 10 (13.0) .515
 Hyperlipidemia 110 (18.0) 11 (13.9) 31 (21.5) .357 39 (11.6) 19 (10.4) 12 (15.6) .489
 Obesity 79 (12.9) 12 (15.2) 11 (7.6) .154 29 (8.6) 20 (10.9) 3 (3.9) .185
 Family history 52 (8.5) 4 (5.1) 11 (7.6) .562 30 (8.9) 12 (6.6) 6 (7.8) .635
Smoking, n (%)
 Current smokers 105 (17.2) 11 (13.9) 23 (16.0) .050 67 (19.9) 27 (14.8) 19 (24.7) .285
 Former smokers 107 (17.4) 10 (12.7) 12 (8.3)   39 (11.6) 28 (15.3) 8 (10.4)  
 Never smokers 400 (65.4) 58 (73.4) 109 (75.7)   230 (68.5) 128 (69.9) 50 (64.9)  
Alcohol consumption, n (%)
 None 414 (67.6) 54 (68.4) 108 (75.0) .322 249 (74.1) 133 (72.7) 56 (72.7) .367
 Moderate 141 (23.0) 20 (25.3) 23 (16.0)   63 (18.8) 28 (15.3) 15 (19.5)  
 Heavy 57 (9.3) 5 (6.3) 13 (9.0)   24 (7.1) 22 (12.0) 6 (7.8)  
2) Stroke characteristics
Ischemic type (TOAST)
 Large-artery atherosclerosis 278 (45.4) 51 (64.6) 67 (46.5) .052 167 (49.7) 94 (51.4) 46 (59.7) .662
 Small-artery occlusion 155 (25.3) 11 (13.9) 39 (27.1)   60 (17.9) 34 (18.6) 12 (15.6)  
 Cardioembolism 89 (14.5) 5 (6.3) 17 (11.8)   59 (17.6) 28 (15.3) 7 (9.1)  
 Other determined 36 (5.9) 4 (5.1) 5 (3.5)   15 (4.5) 5 (2.7) 4 (5.2)  
 Undetermined ischemic stroke 54 (8.8) 8 (10.1) 16 (11.1)   35 (10.4) 22 (12.0) 8 (10.4)  
Ischemic location
 Rt. hemisphere 309 (50.5) 39 (49.4) 64 (44.4) .394 135 (40.2) 68 (37.2) 33 (42.9) .667
 Lt. hemisphere 247 (40.4) 31 (39.2) 70 (48.6)   178 (53.0) 106 (57.9) 38 (49.4)  
 Both hemisphere 56 (9.2) 9 (11.4) 10 (6.9)   23 (6.8) 9 (4.9) 6 (7.8)  
Affected level
 Cortical level 203 (33.2) 32 (40.5) 49 (34.0) .047* 143 (42.6) 75 (41.0) 32 (41.6) .729
 Subcortical level 193 (31.5) 20 (25.3) 30 (20.8)   83 (24.7) 53 (29.0) 21 (27.3)  
 Brainstem level 125 (20.4) 11 (13.9) 40 (27.8)   42 (12.5) 20 (10.9) 13 (16.9)  
 Multiple level 91 (14.9) 16 (20.3) 25 (17.4)   68 (20.2) 35 (19.1) 11 (14.3)  
3) Treatment characteristics
IV thrombolysis 40 (6.5) 5 (6.3) 9 (6.3) .991 27 (8.0) 16 (8.7) 7 (9.1) .935
IA thrombolysis 9 (1.5) 2 (2.5) 3 (2.1) .722 20 (6.0) 4 (2.2) 1 (1.3) .049*
IV heparin 52 (8.5) 5 (6.3) 9 (6.3) .575 29 (8.6) 10 (5.5) 8 (10.4) .301
Antiplatelet agent 485 (79.2) 65 (82.3) 115 (79.9) .818 239 (71.1) 131 (71.6) 53 (68.8) .901
Rehabilitation Therapy 157 (25.7) 25 (31.6) 43 (29.9) .363 133 (39.6) 54 (29.5) 36 (46.8) .015*
Cognitive Therapy 26 (4.2) 4 (5.1) 5 (3.5) .844 19 (5.7) 11 (6.0) 10 (13.0) .061
4) Neuropsychological assessments
Cognitive function (K-MMSE)
 3 months from onset 26.86 ± 3.41 a 23.18 ± 3.69 b 25.85 ± 3.82 c .000** 14.46 ± 9.71 15.95 ± 7.64 16.08 ± 7.09 .112
 12 months from onset 26.88 ± 3.50 a 27.01 ± 3.30 a 20.66 ± 4.90 b .000** 14.68 ± 9.95 a 22.46 ± 5.78 b 10.52 ± 7.21 c .000**
 Variation (from 3 months to 12 months) 0.03 ± 1.17 a 3.84 ± 1.31 b −5.19 ± 3.05 c .000** 0.21 ± 1.10 a 6.51 ± 4.03 b −5.56 ± 2.99 c .000**
Stroke Severity, ADL, Motor, Gait, Depression, QoL (3 months from onset)
 NIHSS 0.78 ± 1.98 a 1.15 ± 2.06 a 1.32 ± 2.15 b .009** 5.75 ± 7.43 a 3.17 ± 4.69 b 5.08 ± 4.68 b .000**
 mRS 1.12 ± 1.12 a 1.51 ± 1.32 b 1.63 ± 1.25 b .000** 2.79 ± 1.68 a 2.37 ± 1.54 b 3.26 ± 1.29 a .000**
 FIM 117.40 ± 15.58 a 113.08 ± 18.30 ab 111.16 ± 19.83 b .000** 83.68 ± 39.78 a 95.74 ± 32.33 b 81.34 ± 31.60 a .001**
 K-MBI 93.31 ± 16.11 a 89.09 ± 17.82 ab 87.34 ± 19.10 b .000** 64.13 ± 38.83 a 75.71 ± 30.51 b 61.61 ± 32.50 a .001**
 FMA (affected side) 93.92 ± 16.11 90.53 ± 19.31 91.44 ± 17.83 .094 70.49 ± 36.80 a 81.45 ± 30.54 b 65.90 ± 35.97 a .000**
 FAC 4.51 ± 1.05 a 4.15 ± 1.40 b 4.00 ± 1.35 b .000** 2.83 ± 2.10 a 3.45 ± 1.79 b 2.70 ± 1.87 a .001**
 GDS 5.40 ± 3.79 a 6.83 ± 4.19 b 7.41 ± 4.35 b .000** 7.63 ± 4.09 a 8.03 ± 4.27 ab 9.65 ± 4.04 b .022*
 EQ-5D 0.76 ± 0.29 a 0.67 ± 0.34 b 0.63 ± 0.36 b .000** 0.39 ± 0.41 a 0.49 ± 0.40 b 0.31 ± 0.37 a .003**
  1. n, Number; SD, Standard Deviation; BMI, Body Mass Index; TOAST, Trial of Org 10172 in Acute Stroke Treatment; Rt, Right; Lt, Left; IV, Intra-Venous; IA, Intra-Artrial; K-MMSE, Korean Mini Mental State Examination; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale; ADL, Activity of Daily Living; FIM, Functional Independence Measure; K-MBI, Korean version of Modified Barthel Index; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulation Categories; GDS, Geriatric Depression Scale; QoL, Quality of Life; EQ-5D, EuroQol-5D
  2. * p < 0.05; ** p < 0.01
  3. abc Post HOC group