Who the fuck cares about predicting dementia? You blithering idiots are supposed be researching how to prevent dementia. GET THERE! Useless.
Sex differences in predictors for cognitive decline and dementia in people with stroke or transient ischemic attack in the PROGRESS trial
Jessica Gonghttps://orcid.org/0000-0001-6027-76401, Katie Harris1, Christophe Tzourio2,3, Stephen Harrap4, Sharon Naismith5,6, Craig S Anderson7,8,9, John Chalmershttps://orcid.org/0000-0002-9931-05801, and Mark Woodward1,10
Background
Background
Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia.
Aims
Aims
We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk.
Methods
Methods
Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs).
Results
Results
Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63–0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72–0.98), with no evidence of sex difference. Higher education (0.96,0.94–0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82–0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02–1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (1.27,1.03–1.58), and peripheral arterial disease (1.78,1.26–2.52) were associated with higher odds of cognitive decline/dementia. APOE ɛ4 was not associated with cognitive decline/dementia (1.05 (0.85–1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03–2.48)). Diabetes was more strongly associated with men than women.
Conclusions
Conclusions
Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia.
Trial Registration: This trial was not registered because enrolment began before 1 July 2005.
Keywords
Stroke, dementia, cognitive decline, sex difference, competing risk
1George Institute for Global Health, University of New South Wales, Sydney, Australia
2Bordeaux Population Health Research Center, Bordeaux University, INSERM, Bordeaux, France
3Hospital Center Bordeaux University, Bordeaux, France
4Department of Physiology, University of Melbourne, Melbourne, Australia
5School of Psychology, University of Sydney, Sydney, Australia
6Brain and Mind Centre, University of Sydney, Sydney, Australia
7George Institute China, Peking University Health Science Center, Beijing, China
8Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia
9Heart Health Research Center, Beijing, China
10George Institute for Global Health, Imperial College London, London, UK
Corresponding author(s):
Jessica Gong, George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW 2042, Australia. Email: jgong@georgeinstitute.org.au
Stroke and transient ischemic attack (TIA) are linked to worse cognition, accelerated cognitive decline (CD), and dementia.1,3–5 Epidemiological and genetic studies suggest overlapping susceptibility factors between CD, dementia, and stroke.6 There are also reciprocal interactions between cerebrovascular disease and neurodegeneration at a pathological level.1,7,8
The Oxford Vascular Study (OxVasc) provided some clarity on how individual characteristics may predict these adverse outcomes.6 Yet, several questions remain, including predictors for cognitive impairment not satisfying criteria for dementia and the generalizability to other ethnicities.9 Death may preclude the development of dementia or CD,7 but this important consideration of death as a competing risk has not been widely incorporated in prior studies of poststroke CD/dementia.
Further, while sex is an important effect modifier for many diseases including stroke and dementia,10 sex differences in risk factors for CD/dementia have not been explored in stroke/TIA. A study in a general population, free of stroke at baseline, found that several risk factors are more strongly associated with incident stroke in women than men.11 Considering the commonality of risk factors for stroke and dementia, sex can have a fundamental influence on their reciprocal relationship.
Trial Registration: This trial was not registered because enrolment began before 1 July 2005.
Keywords
Stroke, dementia, cognitive decline, sex difference, competing risk
1George Institute for Global Health, University of New South Wales, Sydney, Australia
2Bordeaux Population Health Research Center, Bordeaux University, INSERM, Bordeaux, France
3Hospital Center Bordeaux University, Bordeaux, France
4Department of Physiology, University of Melbourne, Melbourne, Australia
5School of Psychology, University of Sydney, Sydney, Australia
6Brain and Mind Centre, University of Sydney, Sydney, Australia
7George Institute China, Peking University Health Science Center, Beijing, China
8Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia
9Heart Health Research Center, Beijing, China
10George Institute for Global Health, Imperial College London, London, UK
Corresponding author(s):
Jessica Gong, George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW 2042, Australia. Email: jgong@georgeinstitute.org.au
Introduction
In 2019, the World Stroke Organization called for joint prevention of dementia and stroke.(This does nothing for that, there is no prevention here.)1 Current trends in global burdens of dementia and stroke projected 200 million stroke survivors and 106 million people with dementia by 2050,2 with 30 million incident stroke and five million deaths from dementia every year thereafter.2Stroke and transient ischemic attack (TIA) are linked to worse cognition, accelerated cognitive decline (CD), and dementia.1,3–5 Epidemiological and genetic studies suggest overlapping susceptibility factors between CD, dementia, and stroke.6 There are also reciprocal interactions between cerebrovascular disease and neurodegeneration at a pathological level.1,7,8
The Oxford Vascular Study (OxVasc) provided some clarity on how individual characteristics may predict these adverse outcomes.6 Yet, several questions remain, including predictors for cognitive impairment not satisfying criteria for dementia and the generalizability to other ethnicities.9 Death may preclude the development of dementia or CD,7 but this important consideration of death as a competing risk has not been widely incorporated in prior studies of poststroke CD/dementia.
Further, while sex is an important effect modifier for many diseases including stroke and dementia,10 sex differences in risk factors for CD/dementia have not been explored in stroke/TIA. A study in a general population, free of stroke at baseline, found that several risk factors are more strongly associated with incident stroke in women than men.11 Considering the commonality of risk factors for stroke and dementia, sex can have a fundamental influence on their reciprocal relationship.
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