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General Cognitive Function in Acute Stroke: The Copenhagen Stroke Study

Department of Neurology Bispebjerg Hospital

Henrik Stig Jørgensen, MD

Department of Neurology Bispebjerg Hospital

Hirofumi Nakayama, MD, PhD

Department of Neurology Bispebjerg Hospital

Hans Otto Raaschou, MD

Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark

Tom Skyhøj Olsen, MD, PhD

Department of Neurology Bispebjerg Hospital

Specific neuropsychological symptoms like aphasia and neglect are well-known in stroke. General cognitive function in stroke patients has been given less attention. The Mini-Mental State Examination (MMSE) is widely used in different neurologic and psychiatric conditions. It has also been used in studies of depression with stroke and for validation of other instruments, but few studies have reported basic data con cerning MMSE in stroke. We assessed 541 unselected acute stroke patients prospec tively and consecutively with the MMSE. Its utility for functional prognosis was deter mined by multiple linear regression analyses of ADL function at discharge measured with the Barthel Index (BI), of length of rehabilitation, and by a logistic regression analysis of the rate of discharge to independent living. A considerable number of patients could not cooperate for the MMSE in the acute stage (42%, including uncon scious and aphasic patients). Reduced cognitive function was found to be common in stroke: a score below the cut-off level of 24 was found in 42%. General cognitive func tion per se had a slight influence on discharge ADL; a ten-point increase in MMSE score corresponded to a four-point increase (p = 0.0009) in BI outcome score. It had no influence on length of rehabilitation, but a ten-point increase in MMSE score increased the chance for discharge to independent living by a factor of 1.78 (95% CI 1.30 to 2.26). In spite of the limited number of stroke patients who can cooperate with the MMSE in the acute phase, a high incidence of reduced general cognitive func tion was found, and the level of general cognitive function was useful for prognosti cation and planning of rehabilitation. Key Words: Cerebrovascular disorders—Stroke— Mini-Mental State Examination—Intellectual function—Dementia—Rehabilitation.

Neurorehabilitation and Neural Repair, Vol. 10, No. 3, 153-158 (1996)
DOI: 10.1177/154596839601000302


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