Supplementary Material for: Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death

Introduction: Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. Methods: We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14–180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, Results: The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04–2.09) and death (hazard ratio, 1.87; 95% CI: 1.25–2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06–2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14–2.67) were associated with an increased risk of death. Discussion/Conclusion: After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.引言：卒中后认知障碍（poststroke cognitive impairment）患者似乎面临更高的复发性脑卒中（recurrent stroke）及死亡风险。然而，腔隙性脑卒中（lacunar stroke）后发生的认知障碍是否与复发性脑卒中及死亡相关，目前尚不明确。本研究旨在评估腔隙性脑卒中后全面认知障碍或特定领域认知障碍是否与复发性脑卒中及死亡存在关联。 方法：本研究纳入来自小皮质下脑卒中二级预防（Secondary Prevention of Small Subcortical Strokes, SPS3）试验的患者，这些患者在确诊腔隙性脑卒中后14~180天内接受了由认证SPS3研究人员以英语实施的基线认知评估。本研究将认知筛查量表（Cognitive Assessment Screening Instrument）得分≤86分定义为全面认知障碍。 结果：本研究共纳入1528名参与者，确诊脑卒中后入组的中位时间为62天。在平均3.9年的随访期间，11.4%的参与者发生复发性脑卒中，8.2%的参与者死亡。在完全校正模型中，记忆障碍与复发性脑卒中（风险比，1.48；95%置信区间[95% CI]：1.04~2.09）及死亡（风险比，1.87；95% CI：1.25~2.79）风险升高独立相关。全面认知障碍（风险比，1.66；95% CI：1.06~2.59）与非记忆障碍（风险比，1.74；95% CI：1.14~2.67）均与死亡风险升高相关。 讨论/结论：腔隙性脑卒中后，记忆障碍是复发性脑卒中及死亡的独立预测因子，而全面认知障碍与非记忆障碍则与死亡风险相关。对腔隙性脑卒中患者开展认知筛查，有助于识别复发性脑卒中及死亡风险更高的人群。