To estimate the frequency of dementia and evaluate patterns of cognitive impairment among young stroke survivors.

Post stroke cognitive impairment has been reported to occur in up to 50% of young stroke survivors. As many young stroke subjects live several decades after stroke, cognitive impairment can have significant impact on quality of life.

This hospital based cross-sectional study from a tertiary care institute in India included 150 stroke subjects aged 18 to 45 years at index stroke, after ≥ 3 months of ictus. Individuals with significant aphasia, delirium were excluded. Memory, fluency, language, attention and visuospatial domains were assessed using Addenbrooke’s cognitive examination III Tamil version (ACEIII). Performance below 2 SD compared to 20 matched controls was considered abnormal. Vascular dementia was diagnosed according to NINDS-AIREN criteria. Disability was graded using modified Rankin score (mRS). Univariate and multivariate analysis were performed for factors associated with dementia. All statistical analysis was carried out using STAT ver 14.2, StataCorp, Texas USA.

At assessment, mean age was 39.3 years (SD 6.6), 47 (27.7%) were women, 107 (71.3%) had mRS≤2, 75 (44%) had ≥10 years of education and median time from stroke was 24 months (IQR 14-38). Normal cognition was noted in 47 (31.3%) and 103 (68.7%) performed <2SD in ≥1 domain. Single domain involvement was seen in 32 (21.3%). The most common domain affected was visuospatial (70; 46.7%) while memory was least (33,22%). Criteria for dementia were met by 32 (21%; 95%CI: 15.1-28.7%). Age, sex, vascular risk factors, post stroke epilepsy and mRS were similar between those with and without dementia, while lower levels of education were associated with dementia (OR: 3.45; 95%CI 1.3-10.1).

Most young stroke survivors have worse cognitive performance compared to controls. Lower levels of education were associated with greater risk of dementia.