Pre-stroke and early post-stroke apathy is associated with increased risk of dementia 3 months after stroke.

ABSTRACT

OBJECTIVES: Apathy is a frequent neuropsychiatric syndrome after stroke. We determined whether pre-morbid and early post-stroke apathy predicts dementia 3 months after stroke. METHODS: We included ischemic stroke patients without dementia who participated in the Prospective Observational Polish Study on post-stroke delirium. We used the Neuropsychiatric Inventory and clinician-reported version of Apathy Evaluation Scale to score apathy symptoms before stroke and on day 8 after stroke. Patients underwent neuropsychological examination 3 months after stroke. RESULTS: Of 422 patients with ischemic stroke and without pre-stroke dementia, 194 patients (mean age 67.5 ± 12.3; 45.9% female) underwent neuropsychological examination. Dementia was diagnosed in 21.6% of them. Patients with dementia had higher apathy scores before stroke (mean 0.9 ± 1.7 vs. 0.2 ± 0.9, p < 0.01) and on day 8 (mean 37.2 ± 9.3 vs. 29.0 ± 9.6, p < 0.01). Depressive symptoms did not differ between groups. In multivariate analysis adjusted for age, diabetes mellitus, stroke severity and in-hospital delirium, apathy symptoms before stroke and on day 8 after stroke predicted post-stroke dementia (adjusted OR 1.59, 95%CI 1.13-2.26, p = 0.01 and OR 1.06, 95%CI 1.01-1.11, p = 0.03, respectively). CONCLUSIONS: Pre-stroke and early post-stroke apathy independently from age, stroke severity and delirium predicted dementia 3 months after stroke. Apathy might be useful in identifying at-risk patients.