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Stability of Estimated Premorbid Cognitive Ability over Time after Minor Stroke and Its Relationship with Post-Stroke Cognitive Ability

Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh Bioquarter, 49 Little France Crescent, Edinburgh EH16 4SB, UK
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
Neuroscience Institute Penn State University, College of Medicine, Penn State Hershey, Hershey, PA 17033, USA
UK Dementia Institute at the University of Edinburgh, Edinburgh EH16 4SB, UK
NHS Fife Victoria Hospital, Kirkcaldy KY2 5AH, UK
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(5), 117;
Received: 25 April 2019 / Revised: 17 May 2019 / Accepted: 20 May 2019 / Published: 22 May 2019
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Considering premorbid or “peak” adult intelligence (IQ) is important when examining post-stroke cognition. The stability of estimated premorbid IQ and its relationship to current cognitive ability in stroke is unknown. We investigated changes in estimated premorbid IQ and current cognitive ability up to three years post-stroke. Minor stroke patients (NIHSS < 8) were assessed at one to three months, one and three years’ post-stroke. The National Adult Reading Test (NART) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) were used to estimate premorbid IQ (NART IQ) and current cognitive ability respectively at each time-point. Baseline demographics, vascular and stroke characteristics were included. Of the 264 patients recruited (mean age 66), 158 (60%), 151 (57%), and 153 (58%) completed cognitive testing at each time-point respectively. NART IQ initially increased (mean difference (MD) = 1.32, 95% CI = 0.54 to 2.13, p < 0.001) before decreasing (MD = −4.269, 95% CI = −5.12 to −3.41, p < 0.001). ACE-R scores initially remained stable (MD = 0.29, 95% CI = −0.49 to 1.07, p > 0.05) before decreasing (MD = −1.05, 95% CI = −2.08 to −0.01, p < 0.05). Adjusting for baseline variables did not change the relationship between NART IQ and ACE-R with time. Increases in NART IQ were associated with more education. For ACE-R, older age was associated with declines, and higher NART IQ and more education was associated with increases. Across 3 years, we observed fluctuations in estimated premorbid IQ and minor changes in current cognitive ability. Future research should aim to identify variables associated with these changes. However, studies of post-stroke cognition should account for premorbid IQ. View Full-Text
Keywords: premorbid intelligence; NART; cognition; stroke premorbid intelligence; NART; cognition; stroke

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McHutchison, C.A.; Chappell, F.M.; Makin, S.; Shuler, K.; Wardlaw, J.M.; Cvoro, V. Stability of Estimated Premorbid Cognitive Ability over Time after Minor Stroke and Its Relationship with Post-Stroke Cognitive Ability. Brain Sci. 2019, 9, 117.

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