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Cognitive impairment and risk of stroke in the older population
L Ferrucci1, J M Guralnik, M E Salive
1Geriatric Department, National Research Institute, Florence, Italy.
Insights
Cognitive impairment in older adults, even without a prior stroke, significantly increases the risk of future strokes. This suggests cerebrovascular disease plays a larger role in cognitive decline than previously thought.
Area of Science:
- Gerontology
- Neurology
- Epidemiology
Background:
- Vascular dementia is increasingly recognized in older populations.
- Cognitive impairment may be an early sign of cerebrovascular disease (CVD).
- The link between cognitive decline and future stroke risk needs further investigation.
Purpose of the Study:
- To determine if cognitive impairment and decline predict future stroke risk in individuals without a history of stroke.
- To assess this association independently of other known risk factors.
Main Methods:
- Population-based prospective study of 5024 elderly individuals.
- Cognitive function assessed using the Short Portable Mental Status Questionnaire (SPMSQ).
- Stroke occurrence tracked via hospital discharge diagnoses and death certificates.
Main Results:
- Higher incidence of stroke observed with increasing cognitive impairment severity.
- Adjusted relative risks for stroke were 1.2 for moderate and 2.2 for severe impairment.
- Cognitive decline, compared to stability or improvement, was associated with increased stroke risk.
Conclusions:
- Cognitive impairment in older adults is a significant predictor of future stroke.
- Cerebrovascular disease may contribute more to cognitive impairment than previously assumed.
- Further research is needed on mitigating CVD risk factors to reduce cognitive impairment burden.
Objective:
Recent studies have suggested that vascular dementia in older persons is more common than previously hypothesized. A substantial proportion of dementia in old age may be an early manifestation of cerebrovascular disease (CVD), that eventually becomes clinically evident as an acute cerebrovascular accident. This study was aimed at assessing whether cognitive impairment and cognitive decline in older persons free of stroke are associated with higher risk of future stroke, independently of other risk factors.
Design:
Population-based prospective study.
Participants:
A total of 5024 subjects from the Established Populations for Epidemiologic Studies of the Elderly, who were alive and had no history of previous stroke at the sixth follow-up visit. Subjects who had reported a stroke in a previous interview or with a diagnosis of cerebrovascular disease in a hospitalization record during the previous 3 years were excluded.
Measurements:
Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Occurrence of a stroke was prospectively assessed by examining hospital discharge diagnoses and death certificates.
Results:
During 19,533 person-years of follow-up, 259 strokes were recorded (13.3/1000 person-years). Stroke incidence was lowest in those with normal SPMSQ score (12.1/1000 person-years), intermediate in those with moderate impairment (16.3/1000 person-years), and highest in those with severe impairment (30.9/1000 person-years). Adjusting for age, education, smoking, history of hypertension, blood pressure, heart attack, diabetes, and disability, the relative risks of stroke for moderate and severe cognitive impairment were 1.2 (0.9-1.6) and 2.2 (1.2-3.8), respectively. The association between cognitive impairment and incident stroke was not mediated by hypertension or diabetes. Compared with subjects with stable or improved SPMSQ score in the previous 3 years, those who declined had higher risk of stroke.
Conclusions:
The elevated risk of subsequent strokes in older persons with cognitive impairment suggests that CVD may play larger role in causing cognitive impairment then previously suspected. It remains to be demonstrated whether reducing modifiable risk factors for CVD decreases the burden of cognitive impairment in older persons without stroke.