Risk Factors for Cognitive Impairment after Ischemic Stroke


Stroke can cause cognitive impairment. Cognitive impairment is brain function disorder that includes impaired orientation, attention, concentration, memory, language and intellectual functions. The aim of this research was to analyze the risk factors for cognitive impairment after ischemic stroke based on risk factors such as age, gender, educational level, record of hypertension, exposure to cigarette smoke, medication adherence, and sleep pattern in ischemic stroke patients in Hajj General Hospital Surabaya. This study is an observational analytic study with case control design. Respondents consisted of 38 cases and 38 control selected through
accidental sampling. Data were obtained from questionnaires named Mini Mental State Examination (MMSE) questionnaire and the Pittsburg Sleep Quality Index (PSQI) questionnaire. The independent variables in this study are age, gender, educational level, record of hypertension, exposure to cigarette smoke, medication adherence, and sleep pattern. The analysis in this study used OR calculation on Epi Info with
significance level 95% CI. The results showed that cognitive impairments in poststroke ischemic’s risk are age (OR = 3,43; 95% CI = 1,08 < OR < 10,89), sex (OR = 2,67; 95% CI = 1.05 < OR < 6,83), educational level (OR = 4,17; 95% CI = 1,60 < OR < 10,86), record of hypertension (OR = 1,60; 95% CI = 0,62 < OR < 4,17), exposure to cigarette
smoke (OR = 1,24; 95% CI = 0,50 < OR < 3,04), medication adherence (OR = 6,59; 95% CI = 2,23 < OR < 19,43), and sleep pattern (OR = 8,125; 95% CI = 2,88 < OR < 22,93). The research results showed that age, gender, level of education, medication adherence, and sleep pattern have a significant OR values and record of hypertension
as well as exposure to cigarette smoke have insignificant OR values. Ischemic stroke patient is suggested to maintain medication compliance and sleep pattern.

Keywords: ischemic stroke, cognitive impairment, risk factors, demographic factors, vascular factors

[1] Kementerian Kesehatan Republik Indonesia. (2014). Riset Kesehatan Dasar Tahun 2013. Retrieved from www.depkes.go.id/resources/download/general/ Hasil Riskesdas 2013.pdf (accessed on October 12, 2016).

[2] Saxena, S. K. (2006). Prevalence and correlates of cognitive impairment in stroke patient in a rehabilitation setting. International Journal of Psychosocial Rehabilitation, vol. 10, no. 2, pp. 37–47.

[3] Martinić-Popović, I., Šerić, V., and Demarin, V. (2006). Early detection of mild cognitive impairment in patient with cerebrovascular disease. Acta clinica Croatica, vol. 45, pp. 77–85.

[4] Harsono. (2007). Kapita Selekta Neurologi. Yogyakarta: Gadjah Mada University Press.

[5] Ratnasari. (2010). Perbedaan Skor Fungsi Kognitif Stroke Iskemik Pertama dengan Iskemik Berulang dengan Lesi Hemisfer Kiri. Surakarta.

[6] Suwantara, J. R. (2004). Depresi pasca stroke: Epidemiologi, rehabilitasi, dan psikoterapi. J. Kedokt. Trisakti, vol. 23, pp. 150–156.

[7] Demarin, V., Kes, V. B., Morović, S., et al. (2009). Evaluation of aging vs dementia by means of neurosonology. Journal of the Neurological Sciences, vol. 283, no. 1–2, pp. 9–12.

[8] T. Tatemichi, M. Paik, E. Bagiella, D. W. Desmond, M. Pirro, and L. K. Hanzawa, “Dementia After Stroke Is a Predictor of Long-term Survival,” Stroke, vol. 25, no. 10, pp. 1915–1919, 1994.

[9] Yudawijaya, A., Kustiowati, E., and Pemayun, G. D. (2011). Homosistein plasma dan perubahan skor fungsi kognitif pada pasien pasca stroke iskemik. Media Medika Indonesiana, vol. 45, no. 1, pp. 8–15.

[10] Pohjasvaara, T., Erkinjuntti, T., Ylikoski, R., et al. (1998). Clinical determinant of poststroke dementia. Stroke, vol. 29, no. 1, pp. 75–81.

[11] Zhou, D. H., Wang, J. Y., Li, J., et al. (2005). Frequency and risk factors of vascular cognitive impairment three months after ischemic stroke in chine: The chongqing stroke study. Neuroepidemiology, vol. 24, no. 1–2, pp. 87–95.

[12] Gorelick, P. B., Scuteri, A., and Black, S. (2011). Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Helathcare Professionals from the American Heart Association/American Stroke Association. Stroke, vol. 42, no. 9, pp. 2672–2713.

[13] Knopman, D. S., et al. (2009). Association of prior stroke with cognitive function and cognitive impairment. Arch Neurology, vol. 66, no. 5, pp. 614–619.

[14] Sachdev, P. S., Brodaty, H., Valenzuela, M. J., et al. (2006). Clinical determinant of stroke and mild cognitive impairment following ischemic stroke: The Sydney stroke study. Dementia and Geriatric Cognitive Disorders, vol. 21, no. 5–6, pp. 275–283.

[15] Myers, J. S. (2008). Factors Associated with changing cognitive function in older adults: Implications for nursing rehabilitation. Rehabilitation Nursing Journal, vol. 33, no. 3, pp. 117–123.

[16] Desmond, D., et al. (2000). Frequency and clinical determinants of dementia after ischemic stroke. Journal of Neurology, vol. 54, no. 5, pp. 1124–1131.

[17] Wu, Y., Wang, M., and Ren, M. (2013). The effects of educational background on montreal cognitive assessment screening for vascular cognitive impairment, no dementia, caused by ischemic stroke. Journal of Clinical Neuroscience, vol. 20, no. 10, pp. 1406–1410.

[18] Evans, D., et al. (1993). Level of education and change in cognitive function in a community population of older persons. Annals of Epidemiology, vol. 3, no. 1, pp. 71–77.

[19] Svensson, T. H. (2000). Dysfunctional brain dopamine systems induced by psychotomimetic NMDA receptor antagonists and the effect of antipsychotic drugs. Brain Research Reviews, vol. 31, no. 2–3, pp. 320–329.

[20] Stroke Association. (2012). Smoking and the Risk of Stroke. Retrieved from https: //www.stroke.org.uk/sites/default/files/smoking_and_the_risk_of_stroke.pdf (accessed on July 04, 2017).

[21] Brucki, S. M., Machado, M. F., and Rocha, M. S. (2012). Vascular Cognitive Impairment (VCI) after non-embolic ischemic stroke during a 12-months follow-up in Brazil. Dementia e Neuropsychologia, vol. 6, no. 3, pp. 164–169.

[22] Martini, S. (2002). Gangguan Kognitif Pascastroke dan Faktor Risikonya. Berita Berkala Kedokteran XVIII, pp. 195–201.

[23] Arnzten, K., Scheimer, H., Wilsgaard, T., et al. (2011). Impact of cardiovascular risk factors on cognitive function: The tromso study. European Journal of Neurology, vol. 18, no. 5, pp. 737–743.

[24] Kalra, L. and Birns, J. (2009). Cognitive function and hypertension. Journal of Human Hypertension, vol. 23, no. 2, pp. 86–96.

[25] Hermann, D. and Bassetti, C. (2009). Sleep-related Breathing and sleep-wake disturbance in ischemic stroke. Journal of Neurology, vol. 73, no. 16, pp. 1313–1322.

[26] Glader, E., Sjolander, M., and Erickson, M. (2010). No titlepersistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke, vol. 41, no. 2, pp. 397–401.

[27] Mellon, L., Brewer, L., and Hall, P. (2015). Cognitive impairment six month after ischaemic stroke: A profile from the ASPIRE-S study. BMC Neurology, vol. 22, pp. 229–238.