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The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study.

Bernice Wiberg¹, Lena Kilander, Johan Sundström

¹Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.

|May 11, 2012

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Pre-stroke executive function, particularly performance on the Trail Making Test (TMT)-A and TMT-B, is linked to higher mortality risk following a first stroke or TIA in older men.

Area of Science:

Neurology
Gerontology
Cognitive Science

Background:

Cognitive decline is a concern in aging populations.
Understanding factors predicting post-stroke outcomes is crucial for patient management.

Purpose of the Study:

To investigate the association between pre-stroke cognitive function and mortality after a first stroke or transient ischemic attack (TIA).

Main Methods:

Prospective cohort study of older men (n=919) from the Uppsala Longitudinal Study of Adult Men.
Cognitive function tests, including Trail Making Test (TMT)-A and TMT-B, were administered around age 70.
Post-stroke survival was analyzed over a median follow-up of 2.5 years for 155 participants experiencing a first stroke or TIA.

Main Results:

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Poor performance on TMT-A before stroke was associated with increased mortality risk (HR 1.88 per SD).
The highest tertile of TMT-A performance showed a nearly threefold higher mortality risk compared to the lowest tertile.
Trail Making Test (TMT)-B also showed a similar pattern, but Mini-Mental State Examination scores did not predict post-stroke mortality.

Conclusions:

Pre-stroke executive function, as assessed by TMT-A and TMT-B, is an independent predictor of long-term mortality after a first stroke or TIA.
These findings highlight the importance of assessing executive function in older men to identify individuals at higher risk for adverse post-stroke outcomes.