Cognitive performance following lacunar stroke in Spanish-speaking patients: results from the SPS3 trial.

Abstract

BACKGROUND:

Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients.

AIMS:

The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients.

METHODS:

The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial.

RESULTS:

Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ≤5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years = 1.52, confidence interval = 1.35-1.71), lower education (odds ratio 0-4 years = 1.23, confidence interval = 0.90-1.67), being a Latin American resident (odds ratio = 1.31, confidence interval = 0.87-1.98), and post-stroke disability (odds ratio Barthel Index <95 = 1.89, confidence interval = 1.43-2.50) were independently associated with mild cognitive impairment.

CONCLUSIONS:

Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.

• Authors: Claudia Jacova, Lesly A Pearce, Ana M Roldan, Antonio Arauz, Jorge Tapia, Raymond Costello, Leslie A McClure, Robert G Hart, Oscar R Benavente
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 10 Issue 4 Pg. 519-28 (Jun 2015) ISSN: 1747-4949 [Electronic] United States
• PMID: 25973704 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 World Stroke Organization.

Topics

• Age Factors
• Aged
• Cognitive Dysfunction (epidemiology, etiology, prevention & control)
• Cohort Studies
• Disability Evaluation
• Educational Status
• Female
• Hispanic or Latino (psychology)
• Humans
• Language
• Latin America (epidemiology)
• Male
• Middle Aged
• Neuropsychological Tests
• Prevalence
• Secondary Prevention
• Spain (epidemiology)
• Stroke, Lacunar (complications, epidemiology, prevention & control, psychology)
• United States (epidemiology)