Background and objectives: Cognitive decline is a major cause of disability in stroke survivors. We aimed to measure changes in cognitive function and to identify factors affecting cognitive change among survivors of ischemic stroke. Methods: All patients with an ischemic stroke were divided into normal cognitive group (NCG) and impaired cognition group (ICG) by using a cutoff score on the Korean Mini-Mental State Examination (K-MMSE) at baseline. Subjects also classified according to longitudinal trajectories of K-MMSE using SAS PROC TRAJ. The characteristic cognitive trajectories were analyzed and demographic and neuroimaging variables were compared among each trajectory subgroup. Results: This study included 892 patients with an ischemic stroke (mean age 64.9 ± 10.8 years). Among these patients, 555 (62.2%) were classified as NCG, while 337 patients (37.8%) were belonged to the ICG. Through trajectory analysis, subjects were further classified into three subgroups for K-MMSE. Within the NCG, 455 patients (82%) were stable group, 43 patients (7.7%) were converter group, and 57 patients (10.3%) were reverter group at 12 months. Within the ICG group, 226 patients (67.1%) were stable group, 80 patients (23.7%) were converter group, and 31 patients (9.2%) were reverter group. Severe stroke, older age, lower education level, the presence of microbleed were associated with ICG and converter trajectory group. Subcortical WMHs were negatively associated with poor cognition. Conclusions: The proportion of stable trajectory group was higher in NCG and converter trajectory group was higher in ICG. The presence of microbleed, subcortical WMHs, severe stroke, and old age were associated with poor cognition converter trajectory.

Trajectory and predictors of Cognitive Decline After Stroke