Burden and Predictors of Poststroke Cognitive Impairment in a Sample of Ghanaian Stroke Survivors

Abstract

Background and Objective: There are limited data on vascular cognitive impairment (VCI) from low- and middle-income countries where the stroke burden is burgeoning. The aim of this study was to characterize the burden, determinants, and effects of VCI on health-related quality of life in sub-Saharan Africa (SSA). Methods: From January 2015 to February 2016, we collected information on 147 consecutive stroke survivors (>45 years) seen at a tertiary hospital in Ghana and 49 demographically matched stroke-free controls. Data collected included demographics, clinical factors, health-related quality of life, and presence of depression. Cognitive status was evaluated using a standard Vascular Neuropsychological Battery that assessed memory, executive function and mental speed, language, and visuospatial–visuoconstructive functioning. Expert VCI guideline and Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition criteria were used to classify stroke patients into no VCI, VCI but no dementia, and vascular dementia (VD). Results: The mean age ± standard deviation of the stroke survivors was 59.9 ± 13.7 years, of which 47.6% were women. Among the cohort, 77 out of 147 (52.3%) had no VCI, 50 of the 147 (34.0%) had VCI without dementia, and 20 of the 147 (13.6%) had VD. Three factors remained significantly associated with VCI: increasing age for each successive 10-year rise (odds ratio [OR] 1.44, 95% confidence interval [CI]: 1.03-2.02), lack of formal education (OR 5.26, 95% CI: 1.01- 27.52), and worse functional disability on the modified Rankin scale (OR 2.46, 95% CI: 1.61-3.75). Patients with VD had the poorest health-related quality of life. Conclusions: Half of the Ghanaian stroke survivors encountered in this crosssectional study had evidence of cognitive dysfunction. Future studies in SSA will need to identify strategies to address this immense burden. Key Words: —risk factors—quality of life—Ghana.