Objective: An estimated 40% of patients experience cognitive impairment 3 months after a stroke. However, there is a lack of knowledge about cognitive improvement after stroke. This exploratory study aims to comprehend the prevalence and patterns of cognitive improvement within the initial 3 months poststroke.
Method: At 1 week and 3 months poststroke, 85 patients aged 40-79 years with supratentorial ischemic stroke and a Mini-Mental State Examination score ≥23 underwent neuropsychological testing of learning, recall, recognition, working memory, verbal fluency, naming, executive function, attention, and processing speed. A hierarchical cluster analysis based on Ward's method and squared Euclidean distance was performed on changes in tests over 3 months to identify homogeneous groups. The within-cluster and between-cluster differences in change were presented descriptively for each cognitive domain. Potential predictors for cluster belonging were compared by independent samples t test or χ2 test.
Results: The cluster analysis identified two clusters. The improvement cluster (n = 22) progressed in learning, recall, recognition, executive function, and most measures of working memory, attention, and verbal fluency. In the stable cluster (n = 63), cognitive function remained stable across most domains, with an increase in a few working memory, verbal fluency and naming, and executive function measures. Notably, 67% of lacunar strokes and 93% of females were in the stable cluster, having less improvement. Age and education did not differentiate between the clusters.
Conclusions: 26% of patients showed overall cognitive improvement within 3 months. Knowing the prevalence and patterns of cognitive improvement after stroke lays the groundwork for future research and clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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This consensus position statement of the American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America updates prior 1994 and 2007 position statements on seizures, driver licensure, and medical reporting. Key consensus positions include the following: (1) in the United States, national driving standards promulgated through a system such as the Uniform Law Commission would reduce confusion and improve adherence with state driving standards; (2) state licensing criteria for medical conditions should be promulgated by regulations and guidelines based on enabling legislation rather than in statutes themselves and should be developed by medical advisory boards working in collaboration with departments of motor vehicles; (3) licensing criteria should be equitable, nondiscriminatory, objective, and compatible with comparable risks in other populations; (4) a minimum seizure-free interval of 3 months should ordinarily be required before driving in all cases and should be extended in individual cases based on review of favorable and unfavorable features by medical advisory boards; (5) individuals with exclusively provoked seizures attributable to provoking factors that are unlikely to reoccur in the future may not require a seizure-free interval before resuming driving; (6) individuals with previously well-controlled epilepsy who experience seizures due to short-term interruptions of antiseizure medications in the setting of hospitalization or practitioner-directed medication-titration may not require a seizure-free interval before driving once previously effective levels of antiseizure medications have been resumed; (7) patients and practitioners should pause driving during tapering and following discontinuation of an antiseizure medication if another such medication is not introduced; (8) individuals whose cognition or coordination is impaired due to medications used to prevent seizures should refrain from driving; (9) health care practitioners should be allowed but not mandated to report drivers who pose an elevated risk; but (10) neither a decision to report a patient suspected of being at elevated risk nor a decision declining to report a patient suspected of being at elevated risk should be subject to legal liability; (11) nations, states, and municipalities should provide alternative methods of transportation and accommodations for individuals whose driving privileges are restricted due to medical conditions.
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