A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke

Objective: To quantitatively characterize domain-specific cognition in individuals with symptomatic lacunar stroke in a systematic review. Methods: Systematic searches of MEDLINE and EMBASE were conducted. Inclusion criteria were all articles published prior to December 2011 evaluating domain-specific cognitive status in individuals with a symptomatic lacunar infarct. Data extraction identified cognitive domains with reported impairment and effect size calculations and heterogeneity analyses were completed to assess the magnitude of this impairment for all studies with control group data. Results: Results of the search yielded 12 cross-sectional and 5 longitudinal studies that met inclusion criteria. Effect size calculations revealed small to medium effect sizes (ES) estimations for impairment after stroke in the domains of executive function (ES -0.44, 95% confidence interval [CI] -0.83, -0.50), memory (ES -0.55, 95% CI -0.96, -0.13), language (ES -0.63, 95% CI -0.92, -0.33), attention (ES -0.37, 95% CI -0.67, -0.07), and visuospatial abilities (ES -0.61, 95% CI -1.03, 0.19), and large effect sizes for global cognition (ES -0.90, 95% CI -1.48, -0.31) and information processing speed (ES -0.93, 95% CI -1.63, -0.23). Heterogeneity analyses revealed that a subset of these domains were heterogeneous and identified moderating factors accounting for this heterogeneity. Conclusions: Results of this systematic review are consistent with previous characterizations of cognitive impairment associated with lacunar strokes. However, impaired cognition in this stroke subtype appears less selective than previously thought, involving all major cognitive domains. Neurology (R) 2013;80:315-322