Prevalence of Cognitive Impairment and Functional Status among the Stroke Survivors in Bangladesh

Md. Julker Nayan; Md. Shamim Miah; KM Shahidul Islam

Md. Julker Nayan^(1*), Md. Shamim Miah⁽²⁾, KM Shahidul Islam⁽³⁾

(1) Junior Consultant & Head, Department of Occupational Therapy, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka-1343, Bangladesh
(2) Scientific Officer, Bangladesh Medical Research Council (BMRC), BMRC Bhaban, Mohakhali, Dhaka, 1212, Bangladesh
(3) Professor and Head, Department of Microbiology, Dhaka Medical College Hospital (DMCH), Dhaka- 1209, Bangladesh
(*) Corresponding Author

Abstract

Stroke is an enormous public health problem in worldwide. Besides physical impairments and functional limitations, cognitive impairments are a common form of disability in stroke survivors. The aim of this study was to identify the prevalence and level of cognitive impairment along with the functional status of the stroke survivors and their association. A descriptive cross-sectional study design was used. By using a purposive sampling technique. In this study, 150 participants were selected for the study based on inclusion criteria. Data were collected using widely used Bangla Adopted Mini-mental State Examination (BAMSE) and Functional Independence Measure (FIM) scales. The mean age of stroke survivors was 53.98 (SD +13.027) years ranging from 23 to 87 years and the male-female ratio is 1.8:1. Almost half (48.7%) of the respondents were living in rural areas. Among the respondents 62.0% had ischemic and 38.0% had a hemorrhagic stroke. Current study results also revealed more than half (52.6%) of the participants had right-sided hemiparesis, and a highly significant association was found between affected body part hemiparesis (affected side of the brain) and cognitive impairment after stroke (x+=0.000 df =2, p = 0.05). Stroke related risk factors showed that Hypertension 68.6%, Diabetes Mellitus 46.7%, Ischemic Heart Disease 23.5%, betel leaf (Paan) 30.7%, and smoking 27% cases. The study results revealed that the prevalence of cognitive impairments among the participants was 40%, among them, 30.67% had severe and 9.33% had mild cognitive impairments based on their BAMSE score. The study also demonstrated that the mean of FIM was 69.91 (SD = 28.57) which indicates that the participants of the study on average minimal contact assistance were required. It was also found that only 30% were independent, whereas 29% were completely dependent and the remaining 41% were modified dependent. There was a highly significant association between cognitive impairment and functional status after stroke (x=0.000 df =2, p = 0.05). Similarly, four domains of FIM were highly associated with the level of cognitive impairment. The prevalence rate of cognitive impairment among the stroke survivors in the rehabilitation setting of Bangladesh is high and so sound cognitive ability needs to be developed among the stroke survivors for ensuring their functional participation. This research gives baseline data to trigger individual stroke survivors and their families, professionals, and policymakers for predicting the functional prognosis and future planning.

Keywords: Stroke Survivors, Cognition, Participation, Rehabilitation