Stroke remains one of the leading causes of mortality and disability, even though there have been advances in treatment. Older men who have impaired cognitive function prior to a stroke are at increased risk of subsequent disability and mortality.

According to a study published in the online journal BMJ Open, a simple drawing test is able to predict the long-term risk of subsequent mortality after first stroke among older men.

The researchers examined data from the Uppsala Longitudinal Study of Adult men, which has been examining various risk factors for stroke and heart disease in 2,322 men starting at the age of 50, in order to find whether there was a reliable way to determine which individuals might be at greater risk of a stroke death, based on cognitive function.

In this study, the team analyzed just under 1,000 of these men who had not been diagnosed with stroke. The mens intellectual capacity was evaluated when they were between 65 and 75 years of age.

Intellectual capacity was assessed using both the Trial Making Test (TMT), which involves drawing lines with a pencil as fast as possible between numbers and/or letters in ascending order, and the mini mental state exam (MMSE), which involves general cognitive tasks, such as memory, numeracy and orientation. MMSE is commonly used to test for dementia.

The researchers found that between 1991 to 2006, 155 men experienced a first minor or major stoke, (transient ischemic attack [TIA]). 22 of the 155 men died within a month of their stroke and 84 men (54%) died within an average of 2.5 years.

The researchers took into account known risk factors, such as social background, education, older age and high blood pressure and found that men who performed badly in the TMT were more likely to have died.

Men were approximately three times more likely to have died after their stroke if their TMT score was in the bottom 30%, compared to those who scored in the highest 30%. The researchers found no association among men who scored badly in the MMSE.

According to the researchers, TMT may result in hidden cognitive impairments that have been caused by silent cerebrovascular disease even though no obvious symptoms have yet been produced.

The researchers highlight the TMT tests “may not only be used as tools for identifying risk of stroke, but may also be considered important predictors of post stroke mortality.”

In addition, a reliable predictor of outcome could also enhance the information patients and their relatives receive.

Written By Grace Rattue