Cognitive Performance following Lacunar Stroke in Spanish-Speaking Patients: Results from the SPS3 Trial

• Published in: International journal of stroke 2015-06, Vol.10 (4), p.519-528
• Main Authors: Jacova, Claudia, Pearce, Lesly A., Roldan, Ana M., Arauz, Antonio, Tapia, Jorge, Costello, Raymond, McClure, Leslie A., Hart, Robert G., Benavente, Oscar R.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Cognitive ability; Cognitive Dysfunction - epidemiology; Cognitive Dysfunction - etiology; Cognitive Dysfunction - prevention & control; cognitive function; cognitive impairment; Cohort Studies; Confidence intervals; Disability Evaluation; Educational Status; Female; Hispanic; Hispanic Americans - psychology; Humans; lacunar stroke; Language; Latin America - epidemiology; Male; Memory; Middle Aged; Neuropsychological Tests; Older people; Prevalence; Secondary Prevention; Spain - epidemiology; Spanish‐speaking; Stroke, Lacunar - complications; Stroke, Lacunar - epidemiology; Stroke, Lacunar - prevention & control; Stroke, Lacunar - psychology; United States - epidemiology
• ISSN: 1747-4930; 1747-4949
• DOI: 10.1111/ijs.12511

Background Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients. Aims The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients. Methods The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1·5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial. Results Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49–57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1·3 to −0·6 non-memory tests; ≤5·0 for Grooved Pegboard; −0·7 to −0·3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years =1·52, confidence interval = 1·35–1·71), lower education (odds ratio 0–4 years = 1·23, confidence interval = 0·90–1·67), being a Latin American resident (odds ratio = 1·31, confidence interval = 0·87–1·98), and post-stroke disability (odds ratio Barthel Index