Hyperglycemia and cognitive outcome after ischemic stroke.

ABSTRACT

BACKGROUND: Post-stroke hyperglycemia (HG) is associated with poor physical recovery, in particular in patients with cortical stroke. We tested whether HG is also associated with cognitive impairment after ischemic stroke. METHODS: We recruited patients from a prospective consecutive cohort with a first-ever supratentorial infarct. Neuropsychological examination included abstract reasoning, verbal memory, visual memory, visual perception and construction, language, and executive functioning. We related HG (glucose >7.0 mmol/L) to cognition and functional outcome (modified Barthel Index) at baseline and after 6-10 months, and to neurological deficit (National Institutes of Health Stroke Scale) and infarct size at baseline. In additional analyses cortical and subcortical infarcts were considered separately. RESULTS: Of 113 patients, 43 had HG (38%) and 55 had cortical infarcts (49%). Follow-up was obtained from 76 patients (68%). In the acute phase, in patients with cortical infarcts HG was associated with impaired executive function (B=-0.65; 95% confidence limits (CL) -1.3-0.00; p<0.05), larger lesion size (p<0.01), and more severe neurological deficits (p<0.01). These associations were not observed in patients with subcortical infarcts and the association between HG and cognitive functioning at follow-up was not significant in either group. CONCLUSIONS: In first-ever ischemic stroke, HG was not associated with impaired cognition after 6-10 months. In the acute phase of stroke HG was associated with impaired executive function, but only in patients with cortical infarcts.