Prevalence and types of cognitive impairment among patients with stroke attending a referral hospital in Uganda

Abstract

Background Cognitive impairment is associated with short and long term adverse outcomes in stroke patients that may impair functional recovery during their rehabilitative process.

Aims This study determined the prevalence, grades and demographic factors associated with cognitive impairment among patients with stroke attending Mulago National Referral Hospital in Uganda, a teaching hospital for Makerere University College of Health Sciences.

Methods This was a cross-sectional descriptive study conducted from Mulago National Referral Hospital between June 2006 and March 2007. Eighty five patients with stroke confirmed by brain computed tomography scan, consenting either by themselves or by their guardians, were consecutively recruited from the Medical wards, Neurology clinic and the Physiotherapy department. A standardized questionnaire was interviewer administered, to obtain demographic and clinical data, and the Mini-Mental State Examination instrument was used to screen and grade cognitive impairment.

Results Of the 85 patients evaluated, 70 (82.4%) had infarct and 15 (17.6%) hemorrhagic stroke. Fifty-four (63%, 95% confidence interval (CI): 53 - 73) had cognitive impairment; of which 23 (27%) and 14 (16%) had mild and moderate cognitive impairment respectively accounting for 43% of the cognitively impaired but with no dementia, and 17 (20%) had severe cognitive impairment (dementia). The only socio-demographic factor associated with cognitive impairment was age . 40 years (odds ratio (OR) 4, 95% CI 1.2 - 13.4, P = 0.024).

Conclusions The prevalence of cognitive impairment among patients with stroke is high. Increasing age is significantly associated with cognitive impairment. There is need for neurocognitive assessment programs among stroke patients and the introduction of rehabilitation services should target to maximize their functional recovery.