Cognitive performance following lacunar stroke in Spanish‐speaking patients: results from the SPS3 trial. Issue 4 (June 2015) - Jacova, Claudia
Abstract 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 <95 = 1·89, confidence interval = 1·43–2·50) were independently associated with mild cognitive impairment. Conclusions Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish‐speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English‐speaking patients. A combination of socio‐demographics, stroke biology, and stroke care may account for these differences.