Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study

Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study Åse Hagen Morsund,1 Hanne Ellekjær,2 Arne Gramstad,3 Magnus Tallaksen Reiestad,4 Rune Midgard,5 Sigrid Botne Sando,6 Egil Jonsbu,7 and Halvor Næss8 1Department of Neurology, Møre and Romsdal Health Trust, Molde hospital, Molde and Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway 2Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim and Stroke Unit, Department of Internal Medicine, St Olavs hospital, University Hospital of Trondheim, Norway 3Department of Neurology, Haukeland University Hospital and Department of Biological and Medical Psychology, University of Bergen, Norway 4Department of psychiatry, Møre and Romsdal Health Trust, Molde hospital, Molde, Norway 5Department of Neurology, Møre and Romsdal Health Trust, Molde hospital, Molde and Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway 6Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim and Department of neurology, St Olavs hospital, University Hospital of Trondheim, Norway 7Department of Psychiatry, Møre og Romsdal Health Trust and Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway 8Department of neurology, Haukeland University Hospital, Centre for age-related medicine, Stavanger University Hospital, Institute of Clinical Medicine, University of Bergen, Norway Correspondence should be addressed to Åse Hagen Morsund; Received 4 December 2018; Revised 18 March 2019; Accepted 19 March 2019; Published 1 April 2019 Academic Editor: Jieli Chen Copyright © 2019 Åse Hagen Morsund et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Aim. To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI). Methods. We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data. Results. 325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function. Discussion and Conclusion. Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities. 1. Introduction Acute ischemic stroke is a heterogeneous clinical syndrome and can lead to a variety of physical and cognitive clinical manifestations. Sensorimotor deficits are usually fairly evident, whereas cognitive deficits may be rather inconspicuous. However, a recent review [1] reported that poststroke dementia might affect as many as 30% of stroke patients. Fatigue has been reported in 34.7% of patients following a minor stroke [2]. Patients with minor strokes are thought to have good long-term prognosis. Sensorimotor symptoms are often marginal at admission and improve quickly the first days and weeks. Most patients are discharged directly to their homes and may have no physical neurological deficits at follow-up after few weeks. However, they may have cognitive symptoms compatible with a mild cognitive impairment or dementia [3–8] and suffer from fatigue [2, 9] and emotional symptoms [3, 10] of longer duration. Anxiety following a minor stroke is less explored [3, 11], whereas subsequent depression and fatigue after minor strokes are better known [2, 3, 10]. These symptoms may have substantial impact on daily functions, rehabilitation, and the patients’ ability to stay in employment after an ischemic stroke [3, 12, 13]. High prevalence of cognitive impairment and depression after TIA and minor stroke are discussed in a systematic review from 2014 [3], but only a few of the included studies were of high quality. The studies revealed large variations in methodology and distribution of included cases [3]. The authors concluded that the knowledge of poststroke anxiety was limited. The prevalence of fatigue was high, but the studies were few and lacked relevant comparison groups. A prospective study from Turkey found significant cognitive impairment in patients with minor stroke and transient ischemic attack compared to controls [5], and, in a prospective Swiss study, poststroke fatigue was found in 34.7% at 12 months after a minor stroke [2]. Assessment of cognitive dysfunction and emotional symptoms is not routinely performed during follow-up and knowledge of the long-term impact of cognitive and emotional symptoms is sparse [3, 5], but attention to this issue is growing [13, 14]. There is no consensus on diagnostic criteria for minor stroke [15–19] which hampers research on this topic. There is consequently a need for studies investigating the consequences of cognitive and emotional impairment of minor strokes. The aim of this study was to assess the prevalence of cognitive and emotional impairment, in patients with minor ischemic stroke. Non-ST-Elevation myocardial infarction (NSTEMI) patients were selected as a control-group because both conditions implicate symptomatic vascular disease and related risk factors with the intracerebral lesion as the difference. Comparison with normative data was included for the cognitive tests. 2. Material and Methods A 12-month follow-up was performed with a selection of cognitive tests and a questionnaire on anxiety, depression, and fatigue. Th (...truncated)