Cognitive Functions and Depression as Predictors of Poor Outcome 15 Months after StrokePohjasvaara T. · Vataja R. · Leppävuori A. · Kaste M. · Erkinjuntti T.
aStroke Unit and bMemory Research Unit, Department of Clinical Neuroscience, and cDepartment of Psychiatry, Psychiatric Consultation Unit, Helsinki University Central Hospital, Helsinki, and dLohja District Hospital, Lohja, Finland
The prognostic predictors of poor outcome, as defined by death between 3 and 15 months and dependent living at 15 months, were examined in the Helsinki Stroke Aging Memory (SAM) study cohort. Death between 3 and 15 months was registered from the whole study group of 486 consecutive patients aged 55–85 years. Altogether 286 of the 486 patients went through a detailed follow-up examination both 3 and 15 months after stroke, including structured measures of emotion (Beck’s Depression Inventory, BDI), cognition (Mini-Mental State Examination, MMSE), dementia assessment according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and handicap (Rankin scale, RS). The only independent correlate of death between 3 and 15 months was dependent living at 3 months (OR 2.6, 95% CI 1.2–5.8), which also had the most powerful association with dependent living at 15 months (OR 5.8, 95% CI 2.6–13.1). Also, both worsening in cognition (change in MMSE, OR for each point of worsening 1.2, 95% CI 1.1–1.3) and worsening of depression (change in BDI, OR for each point of worsening 1.1, 95% CI 1.02–1.12), between 3 and 15 months follow-up, had an independent effect on dependent living 15 months after ischemic stroke. This challenges the care and rehabilitation of these items even at the stable period after stroke.