Magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors: A facility-based cross-sectional study

Abstract

Abstract Background: Stroke is emerging as a public health threat in sub-Saharan African countries including Ethiopia. Even though cognitive impairment is increasingly being recognized as a major cause of disability among stroke survivors there is a paucity of information on the magnitude of stroke-related cognitive dysfunction in Ethiopia. Thus, we assessed the magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors. Methods: A facility-based cross-sectional study was employed to assess the magnitude and predictor of post-stroke cognitive impairment among adult stroke survivors who came for follow-up at least 3 months after the last stoke episode from February to June 2021 in three outpatient neurology clinics in Addis Ababa, Ethiopia. We used the Montreal Cognitive Assessment Scale-Basic (MOCA-B), modified Rankin Scale (mRS), and Patient Health Questionnaire-9 (PHQ-9) to assess post-stroke cognition, functional recovery, and depression, respectively. Data were entered and analyzed using SPSS software version 25. A binary logistic regression model was employed to identify the predictors of post-stroke cognitive impairment. A p-value of 0.05 was considered statistically significant. Results: Of the 79 stroke survivors approached, 67 were included. The mean (SD) age was 52.1 (12.7) years. Over half (59.7%) of the survivors were males and most (67.2%) were urban residents. The median stroke duration was 3 years ranging from 1 to 4 years. Almost half (41.8%) of stroke survivors had cognitive impairment. Increased age (AOR=0.24, 95% CI=0.07,0.83), lower education (AOR=4.02, 95% CI=1.13,14.32), and poor function recovery (mRS ³3) (AOR=0.27, 95% CI=0.08-0.81) were predictors significantly associated with post-stroke cognitive impairment. Conclusion: Nearly one in two stroke survivors had cognitive impairment. The major predictors associated with cognitive decline were age above 45 years, low literacy, and poor recovery in physical function. Although causality cannot be inferred, physical rehabilitation and better education are essential in building cognitive resilience among stroke survivors.