Simple test may help predict long-term outcome after stroke

stroke
Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

A simple test taken within a week of a stroke may help predict how well people will have recovered up to three years later, according to a study published in the October 17, 2018, online issue of Neurology, the medical journal of the American Academy of Neurology.

"We found that this test, which takes less than 10 minutes, can help predict whether people will have impaired thinking skills, problems that keep them from performing daily tasks such as bathing and dressing and even whether they will be more likely to die," said study author Martin Dichgans, MD, of Ludwig-Maximilians University in Munich, Germany. "This test should be used to screen people with and to counsel them and their families about long-term prognosis and also to identify those who would most benefit from interventions that could improve their outcomes."

For the study, 274 people in Germany and France who had a stroke were given the test, called the Montreal Cognitive Assessment, within a week of the stroke. They were then divided into two groups: those with no problems with thinking and and those with cognitive impairment. The participants were tested for their thinking and memory skills, motor functioning and ability to complete daily living tasks six months later and then at one and three years after the stroke.

The study found that those who had thinking problems within one week of the stroke were seven times more likely to die during the three years of the study than those who did not have thinking problems. The survival rate for those with thinking problems after three years was 83 percent, while the rate was 97 percent for those with no thinking problems early on.

Those with thinking problems on the first test were also five times more likely to have problems with their motor skills than those who did not have thinking problems early on. By three years after the stroke, 29 percent of those with thinking problems on the first test had problems with their , compared to 5 percent of those who did not have thinking problems early on.

Those with cognitive impairment were more than twice as likely to have problems completing their daily activities such as bathing and dressing, with 42 percent having problems compared to 13 percent three years after the stroke.

Those with were five times more likely to continue having thinking problems three years after the stroke than the other group.

Dichgans noted that the test helped predict outcomes even when other factors such as the severity of the stroke were taken into account.

A limitation of the study was that most of the people involved had relatively mild strokes, so more research is needed to determine whether the results apply to people with more severe strokes.


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Journal information: Neurology

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