LONG TERM OUTCOMES AMONG AFRICAN STROKE SURVIVORS: FOUR YEARS FOLLOW UP DATA FROM THE COGFAST – NIGERIA STUDY

Gabriel Ogunde^1,2Joshua Akinyemi^2,3Louise Allan⁴Mayowa Ojo Owolabi^1,5Adesola Ogunniyi^1,6Raj Kalaria^1,7Rufus Olusola Akinyemi^1,7,8*

• ¹Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ²Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
• ³Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
• ⁴College of Medicine and Health, University of Exeter, Exeter, England, United Kingdom
• ⁵College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
• ⁶Department of Neurology, University College Hospital, Ibadan, Nigeria
• ⁷Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, United Kingdom
• ⁸Department of Neurology, University College Hospital,, Ibadan, Nigeria

Introduction: Although stroke is recognized as a chronic condition, estimates of different long-term outcomes after stroke are lacking in Africa. This study aimed to explore the profile, trajectory and determinants of long-term outcomes up to four years in a cohort of African stroke survivors. Method: The data analyzed were collected in a longitudinal study of stroke survivors who were prospectively recruited into the CogFAST-Nigeria Study from two specialist hospitals in Nigeria. Subjects with subarachnoid haemorrhage, co-morbid psychiatric or neurologic illness, or any systemic disease that could impair cognition were excluded from the study. Cognition was assessed using the Vascular Neuropsychological Battery, depression with the Geriatric Depression Scale – short form, and functional performance with the Barthel Index. Weibull survival model, generalized estimating equation and linear mixed models were used to identify the predictors of mortality, cognitive impairment, functional performance, and caregiver burden respectively. Result: Of the 253 stroke survivors that were recruited into the study, 157(59.7%) were males while the overall mean age was 60.2±9.8 years.The proportions of those with cognitive impairment were 126/251(50.2%) at three months after stroke, 69/160(43.1%), and 12/36(33.3%) at 1st and 4th year respectively, while the proportion of those with depression was 39.3% at 3 months post-stroke, 35.2%, and 36.1% at year 1 and 4 respectively. Cumulative Mortality increased from 13.8% (95% CI = 10.08-18.63) at nine months post-stroke to 45.3% (95% CI = 39.42 – 51.6) at four years follow-up. The only factor associated with mortality after adjusting for ethnicity was working as an artisan (aHR =2.22; 95% CI = 1.77 – 4.02). History of previous stroke increased the likelihood of functional dependency (OR = 2.17; 95% CI = 1.19 – 3.95). Meanwhile, higher education (OR=0.05; 95% CI=0.02-0.16) protected against cognitive impairment while previous stroke (OR = 2.17; 95% CI = 1.19 – 3.95;) and higher caregiver burden (OR=1.02; 95% CI=1.01-1.02) were associated with increased risk. Conclusion: Improving stroke treatment and rehabilitation is crucial, especially for those with prior stroke, as it strongly predicts poor functional and cognitive outcomes.