Deans' stroke musings: Long-term trajectories of decline in cognition and daily functioning before and after stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, November 16, 2021

Long-term trajectories of decline in cognition and daily functioning before and after stroke

I had zero cognitive decline prior to my stroke and zero decline after my stroke. Still smarter than hell.

Long-term trajectories of decline in cognition and daily functioning before and after stroke

http://orcid.org/0000-0002-5091-0534Alis Heshmatollah1,2,
Lisanne J. Dommershuijsen1,
Lana Fani1,
Peter J. Koudstaal2,
M. Arfan Ikram1,
M. Kamran Ikram1,2

Correspondence to Dr M. Kamran Ikram, Epidemiology and Neurology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands; m.ikram@erasmusmc.nl

Abstract

Objective Although knowledge on poststroke cognitive and functional decline is increasing, little is known about the possible decline of these functions before stroke. We determined the long-term trajectories of cognition and daily functioning before and after stroke.

Methods Between 1990 and 2016, we repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-Word Learning, Letter–Digit Substitution, Stroop, Verbal Fluency, Purdue Pegboard) and basic and instrumental activities of daily living (BADL and IADL) in 14 712 participants within the population-based Rotterdam Study. Incident stroke was assessed through continuous monitoring of medical records until 2018. We matched participants with incident stroke to stroke-free participants (1:3) based on sex and birth year. Trajectories of cognition and daily functioning of patients who had a stroke 10 years before and 10 years after stroke and the corresponding trajectories of stroke-free individuals were constructed using adjusted linear mixed effects models.

Results During a mean follow-up of 12.5±6.8 years, a total of 1662 participants suffered a first-ever stroke. Patients who had a stroke deviated from stroke-free controls up to 10 years before stroke diagnosis in cognition and daily functioning. Significant deviations before stroke were seen in scores of MMSE (6.4 years), Stroop (5.7 years), Purdue Pegboard (3.8 years) and BADL and IADL (2.2 and 3.0 years, respectively).

Conclusion Patients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke.

Data availability statement

Rotterdam Study data can be made available to interested researchers upon request. Requests can be directed to secretariat.epi@erasmusmc.nl. Because of restrictions based on privacy regulations and informed consent of the participants, data cannot be made freely available in a public repository.

http://dx.doi.org/10.1136/jnnp-2021-326043