The Relevance of Right and Left Hemisphere Classification to Predict Cognitive Outcome After Stroke

Introduction: Stroke is the fifth leading cause of disability-adjusted life years (DALYs) in the world. Cognitive impairment is one of the disabilities found in the acute phase of stroke and persists in long-term outcomes which can be assessed using the Mini-Mental State Examination (MMSE). However, a clinical classification to predict the cognitive outcome remained unclear. This study is aimed to identify differences of MMSE results in stroke patients between right and left hemisphere lesions to ensure the mentioned location classifications may contribute to cognitive outcome prediction. Method: With the cross-sectional analytic observational design, 32 acute phase patients hospitalized in the Neurology Department Soetomo General Hospital from October–December 2019 were assessed using the Indonesian version of MMSE with purposive sampling and analyzed using the chi-square test. Result: There was no significant difference between MMSE scores in right or left hemisphere lesion. This might happen because (1) MMSE was insensitive and not a domain-specific test; (2) a more specific infarct location was needed to predict cognitive outcome post-stroke, including microarchitecture of the brain especially those involved in the cortico-striato-thalamocortical loop. Conclusion: The right or left hemisphere lesion classification did not contribute significantly to predict cognitive impairment

Perbedaan Skor Mini-Mental State Examination (Mmse) Pasien Stroke Lesi Hemisfer Kanan Dan Kiri Pada Fase Akut Dalam Perawatan Di Rsud Dr. Soetomo Surabaya

Stroke is the second leading cause of death and fifth leading cause of disability adjusted life years (DALYs) in the world. Many disabilities are found in stroke acute phase and persist in long-term outcomes. One of them is cognitive impairment which can be assessed using Mini-Mental State Examination (MMSE). This study is aimed to identify differences of MMSE result in stroke patients between right and left hemisphere lesion. With cross-sectional analytic observational design, 32 patients hospitalized in the Neurology Department Soetomo General Hospital during October– December 2019 were assessed using Indonesian version of MMSE. Purposive sampling is intended to meet inclusion and exclusion criteria. The most common characteristics found in stroke patients are men, aged 45–65 years, senior high school educated, doing a job as their daily activity, and having hypertension. MMSE results are classified into normal (≥24) and abnormal (<24). Abnormal results are prone to cognitive impairment and identified higher in women patients, aged above 65 years, lower education, and having hypertension. Stroke classification into right or left hemisphere lesion does not contribute significantly to predict any cognitive impairment. There is no significant difference between MMSE scores in right or left hemisphere lesion. This may happen because of irrelevant screening tool or multifactorial samples. MMSE is known as an insensitive tool for right hemisphere lesion and not a domain-specific test. There are also many other factors affecting cognitive impairment, such as stroke severity, size of infarction, and more specific location involving microarchitecture of the brain, especially those in the corticostriato- thalamo-cortical loop