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Cognitive reserve impacts on disability and cognitive deficits in acute stroke

Journal of Neurology volume 266, pages 2495–2504 (2019)Cite this article

Abstract

Objective

Although post-stroke cognitive deficit can significantly limit patient independence and social re-integration, clinical routine predictors for this condition are lacking. ‘Cognitive reserve’ limits the detrimental effects of slowly developing neurodegeneration. We aimed to determine whether comparable effects also exist in acute stroke. Using 'years of education' as a proxy, we investigated whether cognitive reserve beneficially influences cognitive performance and disability after stroke, whilst controlling for age and lesion size as measure of stroke pathology.

Methods

Within the first week of ischemic right hemisphere stroke, 36 patients were assessed for alertness, working memory, executive functions, spatial neglect, global cognition and motor deficit at 4.9 ± 2.1 days post-stroke, in addition to routine clinical tests (NIH Stroke Scale, modified Rankin Scale on admission < 24 h post-stroke and at discharge 9.5 ± 4.7 days post-stroke). The impact of education was assessed using partial correlation analysis adjusted for lesion size, age, and the time interval between stroke and assessment. To validate our results, we compared groups with similar age and lesion load, but different education levels.

Results

In the acute stroke phase, years of education predicted both severity of education independent (alertness) and education dependent (working memory, executive functions, global cognition) cognitive deficits and disability (modified Rankin Scale). Spatial neglect seemed to be independent.

Interpretation

Proxies of cognitive reserve should be considered in stroke research as early as in the acute stroke phase. Cognitive reserve contributes to inter-individual variability in the initial severity of cognitive deficits and disability in acute stroke, and may suggest individualised rehabilitation strategies.

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Acknowledgements

The authors thank Sebastian Kuebel for his help in the neuropsychological testing. This work was supported by funds of the Department of Neurology, Freiburg, the Brain-Links Brain-Tools Cluster of Excellence (Grant number EXC 1086) as well as by Grant KA1258/23-1 funded by the Deutsche Forschungsgemeinschaft (DFG). Christoph Sperber was supported by the Friedrich Naumann Foundation.

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Author notes

  1. Cornelius Weiller and Hans-Otto Karnath contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany

    Roza M. Umarova, Christoph P. Kaller, Charlotte S. M. Schmidt & Cornelius Weiller

  2. Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany

    Roza M. Umarova & Stefan Klöppel

  3. BrainLinks-BrainTools Cluster of Excellence, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany

    Roza M. Umarova, Christoph P. Kaller, Stefan Klöppel & Cornelius Weiller

  4. Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland

    Roza M. Umarova

  5. Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

    Christoph Sperber & Hans-Otto Karnath

  6. Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany

    Horst Urbach

  7. University Hospital of Old Age Psychiatry Bern, University of Bern, Bern, Switzerland

    Stefan Klöppel

  8. Department of Psychology, University of South Carolina, Columbia, USA

    Hans-Otto Karnath

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  1. Roza M. Umarova
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  2. Christoph Sperber
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Contributions

RMU and SK contributed to conception; RMU, CW and CPK contributed to the study design; RMU, HU, CSMS and CW contributed to data acquisition, RMU, CS, CPK, SK and H-OK contributed to data analysis; RMU, CS and H-OK wrote the manuscript.

Corresponding author

Correspondence to Roza M. Umarova.

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Nothing to report.

Ethical standards

The Ethics Committee of the University Medical Centre Freiburg approved the study (10/2013), which was conducted according to the principles of the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from each subject.

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Umarova, R.M., Sperber, C., Kaller, C.P. et al. Cognitive reserve impacts on disability and cognitive deficits in acute stroke. J Neurol 266, 2495–2504 (2019). https://doi.org/10.1007/s00415-019-09442-6

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  • DOI: https://doi.org/10.1007/s00415-019-09442-6

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