Deborah A Levine1, Andrzej T Galecki2, Dolorence Okullo3, Emily M Briceño4, Mohammed U Kabeto3, Lewis B Morgenstern5, Kenneth M Langa6, Bruno Giordani7, Robert Brook3, Brisa N Sanchez8, Lynda D Lisabeth9. 1. Departments of Internal Medicine and Neurology, and University of Michigan Cognitive Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: deblevin@umich.edu. 2. Department of Internal Medicine, University of Michigan Medical School, and Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan. 3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 4. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan. 5. Department of Neurology, University of Michigan, Ann Arbor, Michigan. 6. Department of Internal Medicine, University of Michigan Medical School and VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 7. Departments of Psychiatry and Neurology, University of Michigan Medical School, Professor of Psychology, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan. 8. Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania. 9. Department of Neurology, University of Michigan Medical School, and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
Abstract
BACKGROUND AND AIM: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. METHODS: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. PRIMARY OUTCOME: Modified Mini-Mental Status Examination (3MSE; range, 0-100). SECONDARY OUTCOMES: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. RESULTS: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). CONCLUSIONS: Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.
BACKGROUND AND AIM: It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke. METHODS: Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013. PRIMARY OUTCOME: Modified Mini-Mental Status Examination (3MSE; range, 0-100). SECONDARY OUTCOMES: Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition. RESULTS: Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15). CONCLUSIONS: Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.
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