Jessica W Lo1, John D Crawford1, David W Desmond, Hee-Joon Bae2, Jae-Sung Lim3, Olivier Godefroy4, Martine Roussel4, Yeonwook Kang3,5, Seungmin Jahng6, Sebastian Köhler7, Julie Staals8, Frans Verhey7, Christopher Chen9, Xin Xu10, Eddie J Chong9, Nagaendran Kandiah11,12, Chathuri Yatawara11, Régis Bordet13, Thibaut Dondaine13, Anne-Marie Mendyk13, Henry Brodaty1,14, Latchezar Traykov15, Shima Mehrabian15, Neli Petrova16, Ki Woong Kim17,18,19, Jong Bin Bae19, Ji Won Han19, Darren M Lipnicki1, Ben Lam1, Perminder S Sachdev1,14. 1. Centre for Healthy Brain Ageing (CHeBA), UNSW, Sydney, Australia (J.W.L., J.D.C., H.B., D.M.L., B.L., P.S.S.). 2. Department of Neurology, Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (H.-J.B.). 3. Department of Neurology, Asan Medical Center, Seoul, Republic of Korea (J.-S.L., Y.K.). 4. Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France (O.G., M.R.). 5. Department of Psychology, Hallym University, Republic of Korea (Y.K.). 6. Department of Psychology, Sungkyunkwan University, Republic of Korea (S.J.). 7. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Center Limburg, Maastricht University, the Netherlands (S.K., F.V.). 8. Department of Neurology, School for Cardiovascular diseases (CARIM), Maastricht University Medical Center (MUMC+), the Netherlands (J.S.). 9. Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (C.C., E.J.C.). 10. The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (X.X.). 11. National Neuroscience Institute, Singapore (N.K., C.Y.). 12. Duke-NUS Medical School, Singapore (N.K.). 13. University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, France (R.B., T.D., A.-M.M.). 14. Dementia Collaborative Research Centre, UNSW Medicine, UNSW, Sydney, Australia (H.B., P.S.S.). 15. Clinic of Neurology, UH "Alexandrovska", Medical University - Sofia, Bulgaria (L.T., S.M.). 16. Kaneff University Hospital, Ruse, Bulgaria (N.P.). 17. Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Republic of Korea (K.W.K.). 18. Department of Psychiatry, Seoul National University, College of Medicine, Republic of Korea (K.W.K.). 19. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (K.W.K., J.B.B., J.W.H.).
Abstract
BACKGROUND: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. METHODS: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. RESULTS: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th-75th percentile: 1.21-4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (-0.053 SD/year [95% CI, -0.073 to -0.033]; P<0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=-0.078 SD/year [95% CI, -0.11 to -0.045]; P<0.001 for global cognition in a subgroup analysis). CONCLUSIONS: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.
BACKGROUND: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. METHODS: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. RESULTS: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th-75th percentile: 1.21-4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (-0.053 SD/year [95% CI, -0.073 to -0.033]; P<0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=-0.078 SD/year [95% CI, -0.11 to -0.045]; P<0.001 for global cognition in a subgroup analysis). CONCLUSIONS: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.