Cognitive impairments and impact on activities of daily living after minor stroke.

OBJECTIVE: Describe cognitive impairments and their impact on activities of daily living after a minor stroke in the context of a "pilote" consultation done in hospices civils de Lyon between vascular neurology and physical and rehabilitation services.

MATERIAL/PATIENTS AND METHODS: Thirty patients (21-67 years old) who have cognitive difficulties 6 months after minor stroke were included in the study. All patients received an assessment of complaints and cognitive performances (Montreal cognitive assessment scale, verbal span, 16 items free and cued recall, doors test, rey figure, symbol digit modalities test, verbal fluences, trail making test and the virtual action planning-supermarket test). Impact on activities of daily living was evaluated by cognitive difficulties scale of MacNair and Kahn (MacNair), the reintegration to normal living index (RNLI) and the sickness impact profile-65 (SIP-65). Correlations between cognitive performances and impact on activities of daily living were done (Spearman test).

RESULTS: Eighty percent of patients complained of emotional modifications and 70% have reduced or stopped their work activity. Seventy percent of complaints concerned memory impairment, 54% concerned executive functioning impairment and 77% concerned processing speed impairment. Patients with right and bilateral stroke had a higher number of pathological indices at cognitive performances assessment than patients with left stroke (38 vs 27) and bigger impact on activities of daily living (MacNair: 68 vs 68; QRVN: 69 vs 82; SIP-65: 0.42 vs 0.25, respectively). Finally, there was negative correlation (r=-0.69 et P=0.008) between number of pathological indices and RNLI score.

DISCUSSION - CONCLUSION: Patients who were initially diagnosed with minor stoke have persistent cognitive impairments at 6 months which have an impact on work and quality of life (mRS=2). These impairments are dominant after right and bilateral stroke. They justify development of pluriprofessionnal consultations after a stroke (sixth action of stroke plan 2010-2014) and cognitive remediation protocols.