Early neuropsychological evaluation in patients with ischaemic stroke provides valid information

van Zandvoort, M.J.E.; Kessels, R.P.C.; Nys, G.M.S.; de Haan, E.H.F.; Kappelle, L.J.

doi:10.1016/j.clineuro.2004.10.012

« Previous Next »Clinical Neurology and Neurosurgery
Volume 107, Issue 5 , Pages 385-392, August 2005

Early neuropsychological evaluation in patients with ischaemic stroke provides valid information☆

M.J.E. van Zandvoort
- Helmholtz Instituut, Psychological Laboratory, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
- Corresponding author. Tel.: +31 30 2532970; fax: +31 30 2534511.
R.P.C. Kessels
- Helmholtz Instituut, Psychological Laboratory, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
G.M.S. Nys
- Helmholtz Instituut, Psychological Laboratory, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands
E.H.F. de Haan
- Helmholtz Instituut, Psychological Laboratory, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
L.J. Kappelle
- Department of Neurology, University Medical Center, Utrecht, The Netherlands

Received 13 August 2004; received in revised form 8 October 2004; accepted 25 October 2004.

Abstract

Objectives:

This study describes the feasibility and validity of neuropsychological evaluation in the early stage post-stroke. Early information on cognitive functioning in stroke patients could improve discharge decision, programming of rehabilitation strategies, and better prepare proxies for the problems they can be presented with in daily life. In this explorative study, our primary focus was on the feasibility of early neuropsychological evaluation. Furthermore, we looked at the possible prognostic relevance of early examination.

Patients and methods:

Fifty-seven consecutive patients (age 19–80) were enrolled within 4–20 days after their first ischaemic stroke (Modified-Rankin Scale (M-RS): 2–4). Patients were re-tested after 12–24 months, and functional outcome was assessed.

Results:

In the early stage 44 (77%), patients could complete 82% of the administered tasks. At second evaluation, test performances improved, but a stable test profile was found with respect to abnormalities on the different tasks (P<0.0001). Moreover, initial sum scores of all composite cognitive domains including intellectual functioning (R²=0.80), language (R²=0.76), memory (R²=0.32), perception and visuospatial construction (R²=0.60), attention and psychomotor-functioning (R²=0.80) had significant predictive validity with respect to functional outcome (P<0.001).

Conclusion:

This study supports the feasibility of early neuropsychological evaluation after ischaemic stroke onset and the prognostic validity for cognitive outcome in the long term.

Keywords: Neuropsychological evaluation, Early diagnostics, Cognitive outcome, Stroke, Post-stroke depression, Quality of life