The importance of stroke as a risk factor of cognitive decline in community dwelling older and oldest peoples: the SONIC study

Abstract

Background Cognitive impairment is a major health concern among older and oldest people. Moreover, stroke is a relevant contributor for cognitive decline and development of dementia. The study of cognitive decline focused on stroke as the important risk factor by recruiting older and oldest is still lagging behind. Therefore, the aim of this study was to investigate the importance of stroke as a risk factor of cognitive decline during 3 years in community dwelling older and oldest people. Methods This study was longitudinal study with a 3-year follow-up in Japan. The participants were 1333 community dwelling older and oldest people (70 years old = 675, 80 years old = 589, and 90 years old = 69). Data collected included basic data (age, sex, and history of stroke), vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and current smoking), and social factors (educational level, frequency of going outdoors, long-term care (LTC) service used, and residential area). The Japanese version of the Montreal Cognitive Assessment (MoCA-J) was decline of ≥2 points was defined as cognitive decline. Multiple logistic regression analysis was used to investigate the association between stroke and other risk factors with cognitive decline during a 3-year follow-up. Results The fit of the hypothesized model by multiple logistic regression showed that a history of stroke, advanced age, and greater MoCA-J score at the baseline were important risk factors, while the presence of dyslipidemia and a higher educational level were protective factors that were significantly correlated with cognitive decline during the 3-year follow-up. Conclusions The cognitive decline after the 3-year follow-up was influenced by the history of stroke and advanced age, while greater MoCA-J score at the baseline was positively associated with subsequent 3 years cognitive decline. The protective factors were the presence of dyslipidemia and a higher educational level. Therefore, these factors are considered important and should be taken into consideration when searching for creative solutions to prevent cognitive decline after stroke in community dwelling older and oldest people.

Role of diabetes in stroke: Recent advances in pathophysiology and clinical management

“…DM is associated with increased LA volume and LA is known to be related to cognitive dysfunction and neurodegenerative disorders, such as dementia 199–201 . Furthermore, DM has also been associated with poorer cognitive performance in patients 3 months to 3 years post‐stroke in various studies 202–204 . The relationship between diabetic stroke and long‐term cognitive decline is an area of ongoing research.…”

Effect of Combined Antihypertensive and Lipid-Lowering Therapies on Cognitive Function: A New Treatment Strategy?

“…Elevated blood cholesterol in middle-aged patients increases the risk of AD and vascular dementia and emphasizes the need to resolve the risk factors of dementia before middle age or the onset of potential diseases or symptoms [43][44][45]. However, a longitudinal Japanese study with a 3-year follow-up showed that the presence of dyslipidemia and higher educational levels are protective factors of cognitive decline [46]. Meanwhile some observational studies have found that the use of statins promotes cognitive decline [47], and in 2012 a review published by the Food and Drug Administration (FDA) showed that there is some limited evidence that statin use can lead to cognitive impairment [48,49].…”

Demographic and Clinical Profile of Patients with Mild Cognitive Impairment Seen at St. Luke’s Medical Center-Global City Memory Service

“…There is more emphasis in the recent years on the construct of MCI and its early detection with identification of its risk factors [3][4][5][6][7][8][9] including that of dementia [10]. There are demographic variables that were found to be strongly associated with MCI.…”

“…A recent study identified women, rural residents, those living alone, and with lower level of education to have higher prevalence of MCI [2]. Women [12, 13] and those with less years of formal education [9] were also found to be predictors of cognitive decline.…”

“…Cerebrovascular lesions caused by stroke are negatively associated with cognition [14]. History of prior stroke was also associated with cognitive decline in a 3-year follow-up study among Japanese individuals 70 years and older [9]. More recently, a multicohort stroke study including patients from France, The Netherlands, United Kingdom, Hong Kong, and South Korea found that poststroke cognitive impairment was seen in 43.6% of acute ischemic stroke patients [15].…”