Article

Ten percent of stroke survivors develop dementia, which increases to
more than a third after recurrent stroke. Other survivors develop less severe
vascular cognitive impairment.
In the general population, depression, and
diabetes interact in predicting dementia risk, and they are both prevalent in
stroke. Objective To assess the cumulative association of comorbid depressive
symptoms and type 2 diabetes with cognitive outcomes among stroke survivors.
Methods Multicenter observational cohort study of people within 6 months of
stroke. Depression and cognitive status were screened using the Center for
Epidemiological Studies Depression (CES-D) scale and the Montreal Cognitive
Assessment (MoCA), respectively. Processing speed, executive function and memory
were assessed using the Trail Making Test parts A and B, and the 5 Word Delayed
Free Recall task. Results Among 342 participants (age 67.0 +/- 13.5 years, 43.3%
female, 46 +/- 35 days poststroke), the prevalence of type 2 diabetes was 32.2%
and depressive symptoms (CES-D >/=16) were found in 40.6%. Diabetes and
depressive symptoms increased the risk of severe cognitive impairment (MoCA <20)
with adjusted odds ratio (OR) 2.12 (95% confidence interval [CI] 1.20-3.74, P =
.010) for 1 comorbidity and OR 3.18 (95% CI 1.26-8.02, P = .014) for both
comorbidities. Associated cognitive deficits included executive function (F1, 168
= 3.43, P = .035) but not processing speed (F1, 168 = 1.86, P = .16) or memory
(F1, 168 = 0.82, P = .44). Conclusions Diabetes and depressive symptoms were
associated cumulatively with poorer cognitive screening outcomes poststroke,
particularly deficits in executive function. Having 1 comorbidity doubled the
odds of screening for severe cognitive impairment, having both tripled the odds.
CI - (c) The Author(s) 2016.

Langue : ANGLAIS