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Impact of low mini-mental status on health outcome up to 5 years after stroke: the Erlangen Stroke Project

Journal of Neurology volume 259, pages 1125–1130 (2012)Cite this article

Abstract

Cognitive deficits are frequent stroke sequelae. Data from population-based stroke cohorts on the impact of cognitive deficits on long-term outcome are scarce. The purpose of this study was to investigate the impact of low mini-mental status on health outcome up to 5 years after first-ever stroke. Data were collected from the Erlangen Stroke Project, a population-based stroke registry covering a source population of 103,000 inhabitants. The Mini-Mental State Examination (MMSE) was used to assess global cognitive function. Health outcome included limitations in instrumental activities of daily living (IADL, Frenchay Activities Index), low independence in activities of daily living (ADL, Barthel Index), depressive symptoms (Zung Self Rating Depression Scale), and institutionalization. Using multivariate logistic regression analysis, association of an education-adjusted MMSE score ≤24 with these health outcomes was investigated within distinct models at 12, 36, and 60 months after stroke as well as predictors at 3 months for low IADL. A total of 705 patients with first-ever stroke were included. Institutionalization, low levels of ADL and IADL (p < 0.001) are associated with a MMSE score ≤24 over 5 years after stroke. Predictors at 3 months for low IADL are low mini-mental status up to 3 years after stroke (OR 2.69, 95% CI 1.2–5.8) as well as older age (p < 0.001), and stroke severity (p < 0.001) up to 5 years. A low mini-mental status has an independent impact on long-term health outcome after stroke. Our results emphasize the importance of cognitive status screening to identify stroke survivors at risk and manage and treat these patients more efficiently.

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Acknowledgments

The authors thank their fellow participants of the Erlangen Stroke Project for their help throughout this project: Universitätsklinikum Erlangen, Waldkrankenhaus St. Marien, Klinikum am Europakanal, the General Practitioners Association Erlangen, and the Regional Public Health Office of Erlangen. In addition, the authors would like to express their gratitude to the 100 general practitioners, their staff, and, not least, the patients and their family members without whose cooperation and help this study would not have been possible. The contribution of the 13 research assistants in the Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH) is also gratefully acknowledged. The data collection and data management in the Erlangen Stroke Project is supported by the German Federal Ministry of Health (BMG) as part of the National Information System of the Federal Health Monitoring (Gesundheitsberichterstattung des Bundes—GBE, Project ID: IIA5-2010-2509KEU305). The research leading to these results also received funding from the Federal Ministry of Education and Research (BMBF) through the Grant Center for Stroke Research Berlin (01 EO 0801).

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Affiliations

  1. Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    T. G. Liman, P. U. Heuschmann & M. Endres

  2. Cluster of Excellence NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany

    M. Endres & A. Flöel

  3. Klinik und Poliklinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany

    T. G. Liman, M. Endres & A. Flöel

  4. Department of Neurology, University Hospital Erlangen, Erlangen, Germany

    S. Schwab & P. L. Kolominsky-Rabas

  5. Interdisciplinary Centre for Health Technology Assessment and Public Health, Friedrich-Alexander University of Erlangen-Nurnberg, Erlangen, Germany

    P. L. Kolominsky-Rabas

  6. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistraße 33A, 97080, Würzburg, Germany

    P. U. Heuschmann

Authors
  1. T. G. Liman
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  2. P. U. Heuschmann
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  3. M. Endres
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  4. A. Flöel
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  5. S. Schwab
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  6. P. L. Kolominsky-Rabas
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Correspondence to T. G. Liman.

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Liman, T.G., Heuschmann, P.U., Endres, M. et al. Impact of low mini-mental status on health outcome up to 5 years after stroke: the Erlangen Stroke Project. J Neurol 259, 1125–1130 (2012). https://doi.org/10.1007/s00415-011-6312-6

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  • DOI: https://doi.org/10.1007/s00415-011-6312-6

Keywords

  • Cognitive impairment
  • Health outcome
  • Frenchay activities index
  • First-ever stroke
  • Population-based registry