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Cognitive performance after stroke--the Framingham Heart Study
Galit Weinstein1, Sarah R Preis, Alexa S Beiser
1Department of Neurology, Boston University School of Medicine, Framingham, MA, USA; The Framingham Heart Study, Framingham, MA, USA.
Insights
Clinical stroke significantly impacts cognitive function, leading to poorer performance in memory, learning, language, and executive functions. These deficits persist even after accounting for pre-stroke cognition and vascular risk factors.
Area of Science:
- Neurology
- Cognitive Science
- Epidemiology
Background:
- Individuals at high risk for stroke often experience cognitive impairment due to shared vascular risk factors.
- Clinical stroke is a known risk factor for developing dementia later in life.
- The specific cognitive domains affected by stroke in initially non-demented individuals require further clarification.
Purpose of the Study:
- To identify the specific cognitive domains impacted by clinical stroke.
- To differentiate the effects of stroke on cognition from pre-existing cognitive function and vascular risk factors.
Main Methods:
- A cohort of 132 participants from the Framingham study with prospectively validated strokes were compared to age- and gender-matched controls.
- Cognitive evaluations were conducted approximately six months post-stroke.
- Linear regression models were employed to analyze cognitive score differences, adjusting for prestroke Mini-Mental State Examination (MMSE) scores and vascular risk factors.
Main Results:
- Stroke survivors demonstrated significantly poorer performance in immediate recall of logical and visual memories.
- Deficits were also observed in verbal learning, language (Boston naming test), executive function (digit span backward), and visuospatial/motor skills (block design).
- These cognitive declines were evident independently of prestroke cognitive status and vascular risk factors.
Conclusions:
- Clinical stroke is associated with a subsequent decline across multiple cognitive domains.
- The observed cognitive impairments following stroke are not solely attributable to pre-stroke cognitive function or the presence of vascular risk factors.
Background:
Individuals with a high risk of stroke are also more prone to cognitive impairment perhaps because of concomitant vascular risk factors. In addition, clinical stroke increases the risk of subsequent dementia. Nevertheless, the relationship between clinical stroke and subsequent cognitive function in initially nondemented individuals remains less clear as most prior studies examined case series without controls.
Aims:
To specify among nondemented individuals the cognitive domains affected by clinical stroke, independently of vascular risk factors and prestroke cognition.
Methods:
One hundred thirty-two Framingham study participants (mean age = 77 ± 9 years, 54% women) with prospectively validated initial strokes, as well as age- and gender-matched controls, underwent identical cognitive evaluations ∼six-months after the stroke. Linear regression models were used to assess the differences in cognitive scores between stroke cases and controls adjusting for prestroke cognitive function as assessed by Mini-Mental State Examination scores, and with and without adjustment for vascular risk factors.
Results:
Adjusting for prestroke cognition and vascular risk factors, persons with stroke had poorer cognitive function in the domains of immediate recall of logical and visual memories (β = -1·27 ± 0·60, P = 0·035; β = -1·03 ± 0·47, P = 0·028, respectively), verbal learning (paired associate test; β = -1·31 ± 0·57, P = 0·023), language (Boston naming test; β = -0·27 ± 0·08, P = 0·002), executive function (digit span backward; β = -0·53 ± 0·21, P = 0·015), and visuospatial and motor skills (block design; β = -3·02 ± 1·06, P = 0·005).
Conclusions:
Clinical stroke is associated with subsequent poorer performance in multiple cognitive domains. This association cannot be entirely explained by the individual's cognitive function prior to stroke or by concomitant vascular risk factor levels.