Evaluati̇on of cognitive functions in young ischemic stroke patients

Objective: Stroke is an acute neurological damage condition that develops as a result of ischemia or hemorrhage affecting a part of the brain. Strokes occurring in individuals under the age of 55 are referred to as stroke in young adult. This study aims to investigate cognitive impairment in young stroke patients who have experienced minor ischemic stroke and transient ischemic attack (TIA), determine which cognitive function areas are affected in patients with detected cognitive impairment and assess whether there is any improvement in cognitive functions during follow-up of the patients. Materials and Methods: The study was conducted as a prospective clinical trial at the Neurology Clinic of Ankara Bilkent City Hospital from 01.09.2023 to 01.05.2024. The study included patients aged 18-55 who were hospitalized and diagnosed with TIA or minor stroke at the Neurology Clinic of Ankara Bilkent City Hospital. Early post-stroke disabilities were identified using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at admission and again at 3 months post-stroke. Patients' medical histories, type of ischemic stroke, chronic diseases, stroke risk factors, medication use, and habits were recorded. At admission and at 3 months, patients' hemogram, liver, kidney, and thyroid function tests, electrolytes, lipid profile, vitamin B12, folate, homocysteine, and hemoglobin A1c (HbA1c) levels were reviewed. To assess mood, the Beck Depression Inventory and Beck Anxiety Inventory were administered on the 3rd or 4th day of admission. For cognitive evaluation, the Addenbrooke's Cognitive Examination-Revised (ACER) was used to assess orientation, registration, attention, memory, verbal fluency, language, visual/spatial abilities, perceptual abilities, and recall functions. Cognitive functions were recorded using the same scales at 1 month and 3 months post-stroke. Results: The study included 100 patients from the Neurology Clinic of Ankara Bilkent City Hospital. The mean age of the patients was 47.29 ± 8.40 years (range 19- 55). Based on stroke type, 60 patients were classified as having minor stroke and 40 were classified as having TIA. In patients with minor stroke, anterior system involvement was more common, while no lesions were detected in most patients with TIA (p<0.001). In patients with minor stroke, the average NIHSS and mRS scores at 3 months were statistically significantly lower compared to their admission values (p< 0.05). The average ADB-R score at admission was statistically significantly lower compared to the 1-month value for all patients (p < 0.05). In patients with TIA, the average attention score at admission was statistically significantly lower compared to the 3-month value (p < 0.05). In patients with minor stroke, the average memory score at admission was statistically significantly lower compared to the 1-month and 3- month values (p < 0.05). Anxiety and depression scores at admission were higher in patients with minor stroke and TIA compared to their follow-up scores. The median Beck Depression Inventory value at 1 month was higher in patients with minor stroke compared to those with TIA (p < 0.05). Conclusion: In young patients, the presence of cognitive impairment after TIA and minor stroke is often overlooked in clinical settings, aside from the assessment of motor deficits. It is crucial for clinicians to be informed about cognitive impairment and its follow-up in young patients after a stroke. Identifying patients with cognitive impairment, controlling vascular risk factors and evaluating them for cognitive rehabilitation and medical treatment at the appropriate time are necessary. Monitoring patients for depression is also important. Key words: Stroke in young adult, Transient ischemic attack, Minor stroke, Cognition, Addenbrooke's Cognitive Examination-Revised.