Risk Factors for Poststroke Cognitive Decline

Study Questions:

What are the risk factors for poststroke cognitive decline that are independent of a survivor’s prestroke cognitive trajectory?

Methods:

The authors followed 22,875 participants aged ≥45 years without baseline cognitive impairment from the REGARDS study, who enrolled between 2003 and 2007 through September 2015, to measure the effect of an incident stroke (n = 649) on the changes in cognitive function and cognitive impairment. Mean follow-up was 8.2 years.

Results:

Incident stroke was associated with acute declines in global cognition, new learning, verbal memory, and executive function. Global function declines were greater in survivors who were black, men, who suffered a cardioembolic stroke, or who suffered a large artery stroke. Executive function declines were greater in survivors who had less than a high school education. Incident stroke did not have significant impact on new learning or verbal memory when adjusted for prestroke changes. Declines in global cognition were faster following a stroke for older survivors, those who resided outside the Stroke Belt, and those who survived a cardioembolic stroke. Declines in executive function were faster following a stroke for older survivors and those without hypertension.

Conclusions:

The authors concluded that an incident stroke alters a patient’s cognitive trajectory, most significantly for survivors at older age and who suffered a cardioembolic stroke.

Perspective:

Stroke is one of the most feared cardiovascular complications, often leading to severe morbidity or mortality. This study highlights the impact that an incident stroke may have on a survivor’s cognitive function. Of note for many cardiovascular specialists is the outside impact that cardioembolic strokes have on declines in global cognition and executive function. Therefore, efforts to prevent stroke, especially the use of anticoagulation in patients with atrial fibrillation, are extremely important. Additionally, survivors of black race may experience larger declines in global and executive cognitive function. Targeted efforts to reduce this health disparity are needed at a local, regional, and national level.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension, Sleep Apnea

Keywords: Anticoagulants, Atrial Fibrillation, Cognition, Executive Function, Geriatrics, Hypertension, Learning, Memory, Mild Cognitive Impairment, Primary Prevention, Risk Factors, Stroke, Survivors, Vascular Diseases


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