Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function

Rui She; Zhongrui Yan; Yanlei Hao; Zuoji Zhang; Yifeng Du; Yajun Liang; Davide L Vetrano; Joost Dekker; Bo Bai; Joseph T F Lau; Chengxuan Qiu

doi:10.3389/fnagi.2022.887032

Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function

Front Aging Neurosci. 2022 Sep 9:14:887032. doi: 10.3389/fnagi.2022.887032. eCollection 2022.

Authors

Rui She^{1

2}, Zhongrui Yan³, Yanlei Hao⁴, Zuoji Zhang⁵, Yifeng Du⁶, Yajun Liang^{7

8}, Davide L Vetrano^{8

9}, Joost Dekker¹⁰, Bo Bai⁵, Joseph T F Lau^{11

12}, Chengxuan Qiu^{6

8}

Affiliations

¹ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.
² JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
³ Department of Neurology, Jining No. 1 People's Hospital, Jining, Shandong, China.
⁴ Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
⁵ Department of Neurology, Jining Medical University, Jining, Shandong, China.
⁶ Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
⁷ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁸ Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
⁹ Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome, Italy.
¹⁰ Department of Psychiatry and Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands.
¹¹ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
¹² School of Mental Health, Wenzhou Medical University, Wenzhou, China.

Abstract

The present study examined the prevalence and pattern of comorbidity among Chinese patients with first-ever acute ischemic stroke, and assessed the associations of specific comorbidity patterns with physical and cognitive functioning after stroke occurrence. A hospital-based cross-sectional study was conducted among 2,151 patients with first-ever ischemic stroke (age ≥40 years; 64.2% men) who were admitted to two university hospitals in Shandong, China between 2016 and 2017. Data on demographics, lifestyles, chronic health conditions, and use of medications were collected through in-person interviews, clinical examinations, and laboratory tests. Physical functioning was assessed by the Barthel index (BI) and the modified Rankin Scale (mRS) while cognitive functioning was assessed by the Montreal Cognitive Assessment test. The results showed that comorbidity was present in 90.9% of the stroke patients (women vs. men: 95.2 vs. 88.7%, P < 0.001). Exploratory factor analysis identified three patterns of comorbidity, i.e., patterns of degenerative-cardiopulmonary, heart-gastrointestinal-psychiatric, and metabolic-kidney diseases. The number of comorbidities was significantly associated with a higher likelihood of moderate-to-severe physical dependence [odds ratio (95% CI) = 1.15 (1.06-1.25) for BI and 1.12 (1.04-1.21) for mRS, all P < 0.01] and cognitive impairment [odds ratio (95% CI) = 1.11 (1.02-1.20), P = 0.017], after adjusting for multiple covariates. Almost all the three comorbidity patterns were associated with increased likelihoods of physical dependence (range for odds ratios: 1.26-1.33) and cognitive impairment (range for odds ratios: 1.25-1.34). No significant association was found between degenerative-cardiopulmonary pattern and mRS. These findings suggest that comorbidity is associated with poor physical and cognitive functioning during the acute phase of ischemic stroke. Routine assessments of comorbidity and cognitive and physical function among patients with acute ischemic stroke should be considered in stroke research and clinical practice.

Keywords: China; cognitive impairment; comorbidity; functional dependence; stroke.