Cognitive performance following lacunar stroke in Spanish-speaking patients: results from the SPS3 trial

BackgroundCognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients. AimsThe aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients. MethodsThe baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score -15 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial. ResultsOut of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n=693), the United States (n=121), and Spain (n=363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -13 to -06 non-memory tests; 50 for Grooved Pegboard; -07 to -03 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients=47%, Latin American Spanish-speaking patients=51%, US Spanish-speaking patients=40%, Spanish Spanish-speaking patients=29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years=152, confidence interval=135-171), lower education (odds ratio 0-4 years=123, confidence interval=090-167), being a Latin American resident (odds ratio=131, confidence interval=087-198), and post-stroke disability (odds ratio Barthel Index <95=189, confidence interval=143-250) were independently associated with mild cognitive impairment. ConclusionsMild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.