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Published on: April 23, 2021
Cognitive impairment and risk of future stroke: a systematic review and meta-analysis
Meng Lee1, Jeffrey L Saver1, Keun-Sik Hong1
1Department of Neurology (Lee, Wu), Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Stroke Center and Department of Neurology (Saver, Rao), Geffen School of Medicine, University of California, Los Angeles; Department of Neurology (Hong), Ilsan Paik Hospital, Inje University, Gimhae, South Korea; Department of Psychiatry (Liu), Taipei City Hospital Song-Te Branch, Taipei, Taiwan; Department of Neurosciences (Ovbiagele), Medical University of South Carolina, Charleston, SC.
Background:
Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke.
Methods:
We searched MEDLINE and Embase (1966 to November 2013) and conducted a manual search of bibliographies of relevant retrieved articles and reviews. We included cohort studies that reported multivariable adjusted relative risks and 95% confidence intervals or standard errors for stroke with respect to baseline cognitive impairment.
Results:
We identified 18 cohort studies (total 121 879 participants) and 7799 stroke events. Pooled analysis of results from all studies showed that stroke risk increased among patients with cognitive impairment at baseline (relative risk [RR] 1.39, 95% confidence interval [CI] 1.24-1.56). The results were similar when we restricted the analysis to studies that used a widely adopted definition of cognitive impairment (i.e., Mini-Mental State Examination score < 25 or nearest equivalent) (RR 1.64, 95% CI 1.46-1.84). Cognitive impairment at baseline was also associated with an increased risk of fatal stroke (RR 1.68, 95% CI 1.21-2.33) and ischemic stroke (RR 1.65, 95% CI 1.41-1.93).
Interpretation:
Baseline cognitive impairment was associated with a significantly higher risk of future stroke, especially ischemic and fatal stroke.
