Master Dissertations

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Browsing Master Dissertations by Author "Alphonce, Baraka Ochieng"

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    Prevalence and predictors of post-stroke cognitive impairment among adult patients admitted with first ever stroke intertiary hospitals in Dodoma: a prospective longtudinal observational study
    (The University of Dodoma, 2022) Alphonce, Baraka Ochieng
    Post-stroke survivors are at significantly higher risk of developing cognitive impairment that impacts their quality of life, their families, and the community; however, inadequate attention is given. This study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to a tertiary hospital in Dodoma, Tanzania. The study was a prospective longitudinal study conducted at referral hospitals in the Dodoma region, central Tanzania. A sample of 158 adults with a verified first stroke by brain CT/MRI were recruited. At baseline, social-demographic, cardiovascular risks and stroke characteristics were documented. PSCI was evaluated by Montreal Cognitive Assessment (MoCA) at 30 (baseline) and 90 days, while associated neuropsychiatric factors including depression and apathy were assessed using Personal Health Questionnaire (PHQ-9) and Apathy Evaluation Scale (AES > 38), respectively. Socio-demographic and clinical profiles including age, sex, type and severity of a stroke, and comorbid medical illness were identified at baseline. Continuous data were summarized as Mean (SD) or Median (IQR), and categorical data were summarized using proportions and frequencies. Univariate and multivariate logistic regression analyses were used to determine predictors of PSCI. Of 158 participants, the mean age was 58 (IQR: 15) years, 57.2% were female, and the prevalence of post-stroke cognitive impairment at one and three months was 80.4% and 51.7%, respectively. There was a significant improvement in cognition among 83.7% of the participants at three months. The multivariable logistic regression showed significant association between PSCI and increase in age (AOR: 1.153, CI: 1.088-1.222, p< 0.001), seven years or less of formal education (AOR: 12.775, CI: 8.472-22.653, p< 0.001) and depressive symptoms (AOR: 7.734, CI: 1.359-44.921, p = 0.021). While increase in age (AOR: 0.896, CI: 0.851-0.943, p< 0.001), and female gender (AOR: 0.896, CI: 0.851-0.943, p< 0.001) were independent predictors of no cognitive improvement at three months. In this study, PSCI is prevalent, and four out of five survivors of early PSCI demonstrated cognitive improvement. Profiling at-risk stroke survivors in a timely intervention may improve their prognosis. Future studies in a similar context may exclude premorbid dementia and assess PSCI using a neuropsychological battery.