Thesis defense Pauline Schaapsmeerders (DonderS series 259)
24 January 2017
Promotors: prof. dr. F. de Leeuw, prof. dr. R. Kessels.
Long-term cognitive impairment after first-ever ischemic stroke in young adults
Stroke is the second most common cause of death and major cause of disability worldwide.1 Eighty percent of all strokes are ischemic and are caused by an occlusion of a blood vessel, leading to an ischemic area and accompanying stroke-related neurologic deficit. Besides possible debilitating physical impairments, ischemic stroke has been frequently associated with cognitive impairments2-5 and dementia in stroke survivors aged 60 years and over.6 Although stroke often occurs in these older individuals, up to 14% of all ischemic strokes occur in young adults (18 through 50 years of age).7-13 Furthermore, the incidence of ischemic stroke in the young seems to rise over time.14
Cognitive outcome after ischemic stroke in young adults
The traditionally held view is that the younger the patient with stroke, the more likely the patient will recover. However, studies on stroke outcome are often limited to motor recovery. Although physical disabilities are the most visible disabilities after an ischemic stroke, cognitive impairments, which are often less apparent to others, could have devastating consequences for these young adults. That is, these patients are in a period of life where they start forming a family, will get an education or are preparing for future career steps.
Surprisingly, only a handful of studies focused on cognitive outcome up to one year after stroke in young adults.15, 16 These studies showed that cognitive impairments were frequent in these young patients, but motor recovery was generally favorable.15, 16 As young stroke patients have a long life expectancy, information on long-term cognitive performance exceeding one year is very important to these young individuals.17 Currently, data on the long-term follow-up prognosis of cognitive performance (ten years or more) are lacking. Therefore, it remains unknown if, or to what extent, cognitive decrements can be found years after their ischemic stroke. Providing adequate information is one of the first steps in treatment and management of patients, making it relevant for rehabilitation services.