Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts

 We don't need lazy research describing the trajectory! RESEARCHERS ARE SUPPOSED TO SOLVE THE PROBLEM BY PREVENTING IT! Don't you even have the correct strategy for solving stroke? Or are your leaders BLITHERING IDIOTS?

 And look at all these supposedly smart PhD's!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on survivor requirements of 100% recovery protocols.

Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts

Jessica W. Lo, MSc¹; John D. Crawford, PhD¹; Darren M. Lipnicki, PhD¹; et al Richard B. Lipton, MD²; Mindy J. Katz, MPH²; Pierre-Marie Preux, PhD³; Maëlenn Guerchet, PhD^3,4; Eleonora d’Orsi, PhD⁵; Anna Quialheiro, PhD⁶; Cassiano Ricardo Rech, PhD⁷; Karen Ritchie, PhD⁸; Ingmar Skoog, MD, PhD^9,10; Jenna Najar, MD, PhD^9,11,12; Therese Rydberg Sterner, PhD^13,14; Elena Rolandi, MSc^15,16; Annalisa Davin, MSc¹⁵; Michele Rossi, BS¹⁵; Steffi G. Riedel-Heller, MD¹⁷; Alexander Pabst, PhD¹⁷; Susanne Röhr, PhD^17,18,19; Mary Ganguli, MD²⁰; Erin Jacobsen, MSc²¹; Beth E. Snitz, PhD²²; Kaarin J. Anstey, PhD^23,24,25; Allison E. Aiello, PhD²⁶; Henry Brodaty, MD, DSc¹; Nicole A. Kochan, PhD¹; Yen-Ching Chen, ScD^27,28; Jen-Hau Chen, PhD, MD^29,30; Pascual Sanchez-Juan, MD, PhD³¹; Teodoro del Ser, MD, PhD³¹; Meritxell Valentí, MD, PhD³¹; Antonio Lobo, MD^32,33,34; Concepción De-la-Cámara, MD^32,33,34; Elena Lobo, PhD^32,33,35; Perminder S. Sachdev, MD, PhD¹

Author Affiliations Article Information

JAMA Netw Open. 2024;7(10):e2437133. doi:10.1001/jamanetworkopen.2024.37133

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• Invited Commentary
  Understanding Cognitive Decline After Stroke in the Acute Setting
  Yasmin Sadigh, MSc; Victor Volovici, MD, PhD
  JAMA Network Open

Key Points

Question  What is the outcome of a first stroke on cognitive function?

Findings  In this cohort study of 14 international cohorts of older adults, stroke was associated with a significant acute decline of 0.25 SD in global cognition and a small but significant acceleration in the rate of decline of −0.038 SD per year compared with decline without a previous stroke (−0.049 SD per year). The cognitive performance of stroke survivors before stroke was similar to that of individuals without incident stroke over follow-up.

Meaning  These findings suggest incident stroke is associated with acute and accelerated long-term cognitive decline in older adults.

Abstract

Importance  Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear.

Objective  To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajectory prestroke in stroke survivors with the trajectory of individuals without incident stroke over follow-up.

Design, Setting, and Participants  The study used harmonized and pooled data from 14 population-based cohort studies included in the Cohort Studies of Memory in an International Consortium collaboration. These studies were conducted from 1993 to 2019 across 11 countries among community-dwelling older adults without a history of stroke or dementia. For this study, linear mixed-effects models were used to estimate trajectories of cognitive function poststroke relative to a stroke-free cognitive trajectory. The full model adjusted for demographic and vascular risk factors. Data were analyzed from July 2022 to March 2024.

Exposure  Incident stroke.

Main outcomes and measures  The primary outcome was global cognition, defined as the standardized average of 4 cognitive domains (language, memory, processing speed, and executive function). Cognitive domain scores were formed by selecting the most commonly administered test within each domain and standardizing the scores.

Results  The study included 20 860 participants (12 261 [58.8%] female) with a mean (SD) age of 72.9 (8.0) years and follow-up of 7.51 (4.2) years. Incident stroke was associated with a substantial acute decline in global cognition (−0.25 SD; 95% CI, −0.33 to −0.17 SD), the Mini-Mental State Examination, and all cognitive domains (ranging from −0.17 SD to −0.22 SD), as well as accelerated decline in global cognition (−0.038 SD per year; 95% CI, −0.057 to −0.019 SD per year) and all domains except memory (ranging from −0.020 to −0.055 SD per year), relative to a stroke-free cognitive trajectory. There was no significant difference in prestroke slope in stroke survivors compared with the rate of decline in individuals without stroke in all cognitive measures. The mean rate of decline without a previous stroke was −0.049 SD per year (95% CI, −0.051 to −0.047 SD) in global cognition.

Conclusions and relevance  In this cohort study using pooled data from 14 cohorts, incident stroke was associated with acute and accelerated long-term cognitive decline in older stroke survivors.