The impact of incident stroke on cognitive trajectories in later life

Swarna Vishwanath; Ingrid Hopper; Geoffrey C Cloud; Trevor T-J Chong; Raj C Shah; Geoffrey A Donnan; Jeff D Williamson; Charles B Eaton; Rory Wolfe; Christopher M Reid; Andrew M Tonkin; Suzanne G Orchard; Sharyn Fitzgerald; Anne M Murray; Robyn L Woods; Mark R Nelson; Ajay Sood; Claire J Steves; Joanne Ryan

doi:10.1186/s13195-024-01479-8

The impact of incident stroke on cognitive trajectories in later life

Alzheimers Res Ther. 2024 May 18;16(1):111. doi: 10.1186/s13195-024-01479-8.

Authors

Swarna Vishwanath^{1

2}, Ingrid Hopper^{1

3}, Geoffrey C Cloud^{2

4}, Trevor T-J Chong^{4

5

6}, Raj C Shah⁷, Geoffrey A Donnan⁸, Jeff D Williamson⁹, Charles B Eaton¹⁰, Rory Wolfe¹, Christopher M Reid^{1

11}, Andrew M Tonkin¹, Suzanne G Orchard¹, Sharyn Fitzgerald¹, Anne M Murray^{12

13}, Robyn L Woods¹, Mark R Nelson^{1

14}, Ajay Sood⁷, Claire J Steves¹⁵, Joanne Ryan¹⁶

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
² Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
³ Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Australia.
⁴ Department of Neurology, Alfred Health, Melbourne, VIC, Australia.
⁵ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
⁶ Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, VIC, Australia.
⁷ Department of Family and Preventive Medicine, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
⁸ Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia.
⁹ Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹⁰ Department of Family Medicine and Epidemiology, Brown University Warren Alpert Medical School and School of Public Health, Pawtucket, RI, USA.
¹¹ School of Population Health, Curtin University, Western Australia, Australia.
¹² Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
¹³ Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA.
¹⁴ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
¹⁵ Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.
¹⁶ School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. joanne.ryan@monash.edu.

Abstract

Background: Cognitive impairment is common after stroke, and a large proportion of stroke patients will develop dementia. However, there have been few large prospective studies which have assessed cognition both prior to and after stroke. This study aims to determine the extent to which incident stroke impacts different domains of cognitive function in a longitudinal cohort of older community-dwelling individuals.

Methods: 19,114 older individuals without cardiovascular disease or major cognitive impairment were recruited and followed over a maximum 11 years. Stroke included ischaemic and haemorrhagic stroke and was adjudicated by experts. Cognitive function was assessed regularly using Modified Mini-Mental State Examination (3MS), Hopkins Verbal Learning Test-Revised (HVLT-R), Symbol Digit Modalities Test (SDMT), and Controlled Oral Word Association Test (COWAT). Linear mixed models were used to investigate the change in cognition at the time of stroke and decline in cognitive trajectories following incident stroke.

Results: During a median follow-up period of 8.4 [IQR: 7.2, 9.6] years, 815 (4.3%) participants experienced a stroke. Over this time, there was a general decline observed in 3MS, HVLT-R delayed recall, and SDMT scores across participants. However, for individuals who experienced a stroke, there was a significantly greater decline across all cognitive domains immediately after the event immediately after the event (3MS: -1.03 [95%CI: -1.45, -0.60]; HVLT-R: -0.47 [-0.70, -0.24]; SDMT: -2.82 [-3.57, -2.08]; COWAT: -0.67 [-1.04, -0.29]) and a steeper long-term decline for three of these domains (3MS -0.62 [-0.88, -0.35]; COWAT: -0.30 [-0.46, -0.14]); HVLT-R: -0.12 [95%CI, -0.70, -0.24]). However individuals with stroke experienced no longer-term decline in SDMT compared to the rest of the participants.

Conclusions: These findings highlight the need for comprehensive neuropsychology assessments for ongoing monitoring of cognition following incident stroke; and potential early intervention.

Keywords: Cognitive domains; Cognitive function; Dementia; Linear mixed model; Stroke; Trajectories.

MeSH terms

Aged
Aged, 80 and over
Cognition / physiology
Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / epidemiology
Cognitive Dysfunction* / etiology
Female
Humans
Incidence
Longitudinal Studies
Male
Neuropsychological Tests*
Prospective Studies
Stroke* / complications
Stroke* / epidemiology
Stroke* / psychology

Grants and funding

1135727/National Health and Medical Research Council Research Leader Fellowship