Trajectory of Cognitive Decline After Incident Stroke

Abstract

IMPORTANCE Cognitive decline is a major cause of disability in stroke survivors. The magnitude of survivors' cognitive changes after stroke is uncertain.OBJECTIVE To measure changes in cognitive function among survivors of incident stroke, controlling for their prestroke cognitive trajectories. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 23 572 participants 45 years or older without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, residing in the continental United States, enrolled 2003-2007 and followed up through March 31, 2013. Over a median follow-up of 6.1 years (interquartile range, 5.0-7.1 years), 515 participants survived expert-adjudicated incident stroke and 23 057 remained stroke free. EXPOSURE Time-dependent incident stroke. MAIN OUTCOMES AND MEASURES The primary outcome was change in global cognition (Six-Item Screener [SIS], range, 0-6). Secondary outcomes were change in new learning (Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; range, 0-30), verbal memory (Word-List Delayed Recall; range, 0-10), and executive function (Animal Fluency Test; range, Ն0), and cognitive impairment (SIS score <5 [impaired] vs Ն5 [unimpaired]). For all tests, higher scores indicate better performance. RESULTS Stroke was associated with acute decline in global cognition (0.10 points [95% CI, 0.04 to 0.17]), new learning (1.80 points [95% CI, 0.73 to 2.86]), and verbal memory (0.60 points [95% CI, 0.13 to 1.07]). Participants with stroke, compared with those without stroke, demonstrated faster declines in global cognition (0.06 points per year faster [95% CI, 0.03 to 0.08]) and executive function (0.63 points per year faster [95% CI, 0.12 to 1.15]), but not in new learning and verbal memory, compared with prestroke slopes. Among survivors, the difference in risk of cognitive impairment acutely after stroke, compared with immediately before stroke, was not statistically significant (odds ratio, 1.32 [95% CI, 0.95 to 1.83]; P = .10); however, there was a significantly faster poststroke rate of incident cognitive impairment compared with the prestroke rate (odds ratio, 1.23 per year [95% CI, 1.10 to 1.38]; P < .001). For a 70-year-old black woman with average values for all covariates at baseline, stroke at year 3 was associated with greater incident cognitive impairment: absolute difference of 4.0% (95% CI, −1.2% to 9.2%) at year 3 and 12.4% (95% CI, 7.7% to 17.1%) at year 6.CONCLUSIONS AND RELEVANCE Incident stroke was associated with an acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years.

Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study

“…Thus, we could only assess global cognition rather than specific domains of cognition, which may have yielded different results. The strengths of this study included the population-based design, good sample size, and inclusion of an extensive range of baseline covariates, which have not been considered in previous population-based studies [17, 35]. …”

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Design and protocols of the GIRAF prevention trial: A randomized, prospective, parallel, two-center study to compare cognitive outcomes in subjects with atrial fibrillation using warfarin or dabigatran

“…Likewise, it is suggested that in patients with AF, choices regarding anticoagulation as well as rhythm and rate-control could play an important role in the risk/progression of dementia. 29,30 It is recognized that vascular cognitive impairment, as observed in AF patients with stroke and TIA, is mainly associated with deficits in executive function, attention and information processing. 31,32 Afterwards, it is clear that efforts to improve quality of life focused on patients with AF by preventing unfavorable outcomes such as cognitive and functional impairments are extremely important and necessary.…”

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