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The frequency and determinants of executive dysfunction among patients with subacute phase of ischemic stroke in West Nusa Tenggara, Indonesia

Abstract

Background: Executive dysfunction is a common form of intellectual weakening that interferes with the functional activity of the stroke survivors. Detection of executive dysfunction in the subacute segment of ischemic stroke allows the patients to receive appropriate interventions for optimal clinical outcomes. This study aims to investigate the frequency and determinants of executive dysfunction among subacute ischemic stroke patients in West Nusa Tenggara.

Methods: This study involved 192 subjects divided into two groups: ischemic stroke (n=96) and control groups (n=96). Categorical data collected from both ischemic stroke and control subjects were age, gender, education level, occupation, hypertension, diabetes mellitus, Trail Making Test Part B, verbal fluency test, backward digit span scores and executive function status. Besides the data previously mentioned, clinical data that were also collected in ischemic stroke subjects was infarct size. The significant difference in the frequency of executive dysfunction between ischemic stroke and control groups was analyzed using chi-square test. The association between the determinants of executive dysfunction and the frequency of this executive dysfunction was analyzed using logistic regression.

Results: This study discovered that the frequency of executive dysfunction among subjects with subacute phase of ischemic stroke was 52.1% and it was significantly higher compared with controls (p<0.0001). Further, lower education level was the only determinant significantly correlated with the increased risk of executive dysfunction in the subjects (Odds ratio [OR] =3.47; 95% confidence interval [CI] = 1.47 – 10.26).

Conclusion: There was high frequency of subacute ischemic stroke-associated executive dysfunction associated with lower education level.

References

  1. Qu Y, Zhuo L, Li N, Hu Y, Chen W, Zhou Y, et al. Prevalence of poststroke cognitive impairment in china a community-based, cross-sectional study. PLoS One. 2015;10(4):e0122864. Available from: https://doi.org/10.1371/journal.pone.0122864
  2. Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019;93(24):E2257–71. Available from: https://pubmed.ncbi.nlm.nih.gov/31712368
  3. Jaillard A, Naegele B, Trabucco-Miguel S, LeBas JF, Hommel M. Hidden dysfunctioning in subacute stroke. Stroke. 2009;40(7):2473–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19461036/
  4. Coco D Lo, Lopez G, Corrao S. Cognitive impairment and stroke in elderly patients [Internet]. Vol. 12, Vascular Health and Risk Management. 2016. p. 105–16. Available from: https://pubmed.ncbi.nlm.nih.gov/27069366/
  5. Obaid M, Flach C, Marshall I, Wolfe CDA, Douiri A. Long-term outcomes in stroke patients with cognitive impairment: A population-based study. Geriatr. 2020;5(2):32. Available from: https://pubmed.ncbi.nlm.nih.gov/32443398/
  6. Del Ser T, Barba R, Morin MM, Domingo J, Cemillan C, Pondal M, et al. Evolution of cognitive impairment after stroke and risk factors for delayed progression. Stroke. 2005;36(12):2670–5. Available from: https://pubmed.ncbi.nlm.nih.gov/16254227/
  7. Rohde D, Williams D, Gaynor E, Bennett K, Dolan E, Callaly E, et al. Secondary prevention and cognitive function after stroke: A study protocol for a 5-year follow-up of the ASPIRE-S cohort. BMJ Open. 2017;7(3):e014819. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372058/
  8. Al-Qazzaz NK, Ali SH, Ahmad SA, Islam S, Mohamad K. Cognitive impairment and memory dysfunction after a stroke diagnosis: A post-stroke memory assessment [Internet]. Vol. 10, Neuropsychiatric Disease and Treatment. 2014. p. 1677–91. Available from: https://pubmed.ncbi.nlm.nih.gov/25228808/
  9. Rincon F, Wright CB. Vascular cognitive impairment [Internet]. Vol. 26, Current Opinion in Neurology. 2013. p. 29–36. Available from: https://pubmed.ncbi.nlm.nih.gov/23254555/
  10. Rabinovici GD, Stephens ML, Possin KL. Executive dysfunction [Internet]. Vol. 21, Continuum (Minneap Minn). 2015. p. 646–59. Available from: https://pubmed.ncbi.nlm.nih.gov/26039846/
  11. Povroznik JM, Ozga JE, Haar CV, Engler-Chiurazzi EB. Executive (dys)function after stroke: Special considerations for behavioral pharmacology. Behav Pharmacol. 2018;29(7):638–53. Available from: https://pubmed.ncbi.nlm.nih.gov/30215622/
  12. Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: Still an incomplete picture [Internet]. Vol. 8, International Journal of Stroke. 2013. p. 38–45. Available from: https://pubmed.ncbi.nlm.nih.gov/23280268/
  13. Nys GMS, Van Zandvoort MJE, De Kort PLM, Jansen BPW, De Haan EHF, Kappelle LJ. Cognitive disorders in acute stroke: Prevalence and clinical determinants. Cerebrovasc Dis. 2007;23(5–6):408–16. Available from: https://pubmed.ncbi.nlm.nih.gov/17406110/
  14. Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DKA, Subramaniam P. A Review of Risk Factors for Cognitive Impairment in Stroke Survivors [Internet]. Vol. 2016, Scientific World Journal. 2016. p. 3456943. Available from: https://doi.org/10.1155/2016/3456943
  15. Willis KJ, Hakim AM. Stroke prevention and cognitive reserve: Emerging approaches to modifying risk and delaying onset of dementia. Front Neurol. 2013;4:13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604564/
  16. Westerlind E, Abzhandadze T, Rafsten L, Persson HC, Sunnerhagen KS. Very early cognitive screening and return to work after stroke. Top Stroke Rehabil. 2019;26(8):602–7. Available from: https://doi.org/10.1080/10749357.2019.1645440
  17. Nys GMS, Van Zandvoort MJE, De Kort PLM, Jansen BPW, Van Der Worp HB, Kappelle LJ, et al. Domain-specific cognitive recovery after first-ever stroke: A follow-up study of 111 cases. J Int Neuropsychol Soc. 2005;11(7):795–806. Available from: https://pubmed.ncbi.nlm.nih.gov/16519259/
  18. Stokholm J, Steenholt JV, Csilag C, Kjær TW, Christensen T. Delirium Assessment in Acute Stroke: A Systematic Review and Meta-Analysis of Incidence, Assessment Tools, and Assessment Frequencies. J Cent Nerv Syst Dis. 2019;11:1–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31908562/
  19. M. Faruk F. Regional Social Sustainability Index in Indonesia 2017. J Perenc Pembang Indones J Dev Plan. 2020;4(1):40–53. Available from: https://doi.org/10.36574/jpp.v4i1.103
  20. Conti J, Sterr A, Brucki SMD, Conforto AB. Diversity of approaches in assessment of executive functions in stroke: Limited evidence? [Internet]. Vol. 1, eNeurologicalSci. Elsevier B.V.; 2015. p. 12–20. Available from: https://doi.org/10.1016/j.ensci.2015.08.002
  21. Harahap HS, Akbar M, Bintang AK, Tammasse J, Zainuddin AA. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism rather than homocysteine increase the risk of ischemic stroke-associated executive dysfunction. Bali Med J. 2022;11(1):443–50. Available from: https://doi.org/10.15562/bmj.v11i1.2503
  22. Levine DA, Wadley VG, Langa KM, Howard G, Howard VJ, Cushman M. Risk Factors for Poststroke Cognitive Decline: The REGARDS Study (Reasons for Geographic and Racial Differences in Stroke). Stroke. 2019;49(4):987–94. Available from: https://pubmed.ncbi.nlm.nih.gov/29581343/
  23. Kluwe-Schiavon B. b, Sanvicente-Vieira B. b, Viola TW. b, e Souza LSA., Rigoli MM. c, Fonseca RP. d, et al. Rehabilitation of executive functions: Implications and strategies. Av en Psicol Latinoam. 2013;31(1):110–20. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1794-47242013000100009&lng=en&nrm=iso
  24. Veldsman M, Werden E, Egorova N, Khlif MS, Brodtmann A. Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke. Sci Rep. 2020;10(1):17911. Available from: https://doi.org/10.1038/s41598-020-75074-w

How to Cite

Akbar, M., Tammasse, J., Bintang, A. K., & Harahap, H. S. (2023). The frequency and determinants of executive dysfunction among patients with subacute phase of ischemic stroke in West Nusa Tenggara, Indonesia. Bali Medical Journal, 12(1), 249–254. https://doi.org/10.15562/bmj.v12i1.3789

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Muhammad Akbar
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Jumraini Tammasse
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Andi Kurnia Bintang
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Herpan Syafii Harahap
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