Deborah A Levine1, Virginia G Wadley2, Kenneth M Langa2, Frederick W Unverzagt2, Mohammed U Kabeto2, Bruno Giordani2, George Howard2, Virginia J Howard2, Mary Cushman2, Suzanne E Judd2, Andrzej T Galecki2. 1. From the Department of Internal Medicine (D.A.L., K.M.L., M.U.K., A.T.G.) and Department of Psychiatry (B.G.), University of Michigan Medical School, Ann Arbor; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (D.A.L., K.M.L., M.U.K.); Institute for Healthcare Policy and Innovation (D.A.L., K.M.L.), Department of Neurology and Stroke Program (D.A.L.), Institute for Social Research (K.M.L.), and Department of Biostatistics (A.T.G.), University of Michigan, Ann Arbor; Department of Medicine (V.G.W.) and Department of Biostatistics (G.H., V.J.H., S.J.), University of Alabama School of Medicine, Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); and Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.). deblevin@umich.edu. 2. From the Department of Internal Medicine (D.A.L., K.M.L., M.U.K., A.T.G.) and Department of Psychiatry (B.G.), University of Michigan Medical School, Ann Arbor; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (D.A.L., K.M.L., M.U.K.); Institute for Healthcare Policy and Innovation (D.A.L., K.M.L.), Department of Neurology and Stroke Program (D.A.L.), Institute for Social Research (K.M.L.), and Department of Biostatistics (A.T.G.), University of Michigan, Ann Arbor; Department of Medicine (V.G.W.) and Department of Biostatistics (G.H., V.J.H., S.J.), University of Alabama School of Medicine, Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); and Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.).
Abstract
BACKGROUND AND PURPOSE: Poststroke cognitive decline causes disability. Risk factors for poststroke cognitive decline independent of survivors' prestroke cognitive trajectories are uncertain. METHODS: Among 22 875 participants aged ≥45 years without baseline cognitive impairment from the REGARDS cohort (Reasons for Geographic and Racial Differences in Stroke), enrolled from 2003 to 2007 and followed through September 2015, we measured the effect of incident stroke (n=694) on changes in cognitive functions and cognitive impairment (Six-Item Screener score <5) and tested whether patient factors modified the effect. Median follow-up was 8.2 years. RESULTS: Incident stroke was associated with acute declines in global cognition, new learning, verbal memory, and executive function. Acute declines in global cognition after stroke were greater in survivors who were black (P=0.04), men (P=0.04), and had cardioembolic (P=0.001) or large artery stroke (P=0.001). Acute declines in executive function after stroke were greater in survivors who had <high school education versus college graduates (P=0.01). Incident stroke was associated with faster declines in global cognition and executive function but not new learning or verbal memory compared with prestroke slopes. Faster declines in global cognition over years after stroke were greater in survivors who were older (P<0.01), resided outside the Stroke Belt (P=0.005), or had cardioembolic stroke (P=0.01). Faster declines in executive function over years after stroke were greater in survivors who were older (P<0.01) or lacked hypertension (P=0.03). CONCLUSIONS: Incident stroke alters a patient's cognitive trajectory, and this effect is greater with increasing age and cardioembolic stroke. Race, sex, geography, and hypertension status may modify the risk of poststroke cognitive decline.
BACKGROUND AND PURPOSE:Poststroke cognitive decline causes disability. Risk factors for poststroke cognitive decline independent of survivors' prestroke cognitive trajectories are uncertain. METHODS: Among 22 875 participants aged ≥45 years without baseline cognitive impairment from the REGARDS cohort (Reasons for Geographic and Racial Differences in Stroke), enrolled from 2003 to 2007 and followed through September 2015, we measured the effect of incident stroke (n=694) on changes in cognitive functions and cognitive impairment (Six-Item Screener score <5) and tested whether patient factors modified the effect. Median follow-up was 8.2 years. RESULTS: Incident stroke was associated with acute declines in global cognition, new learning, verbal memory, and executive function. Acute declines in global cognition after stroke were greater in survivors who were black (P=0.04), men (P=0.04), and had cardioembolic (P=0.001) or large artery stroke (P=0.001). Acute declines in executive function after stroke were greater in survivors who had <high school education versus college graduates (P=0.01). Incident stroke was associated with faster declines in global cognition and executive function but not new learning or verbal memory compared with prestroke slopes. Faster declines in global cognition over years after stroke were greater in survivors who were older (P<0.01), resided outside the Stroke Belt (P=0.005), or had cardioembolic stroke (P=0.01). Faster declines in executive function over years after stroke were greater in survivors who were older (P<0.01) or lacked hypertension (P=0.03). CONCLUSIONS: Incident stroke alters a patient's cognitive trajectory, and this effect is greater with increasing age and cardioembolic stroke. Race, sex, geography, and hypertension status may modify the risk of poststroke cognitive decline.
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