Deans' stroke musings: Poststroke Cognitive Decline Across Stroke Types and Ischemic Subtypes: Comprehensive Insights From Levine et al. (2025)

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.

Thursday, July 17, 2025

Poststroke Cognitive Decline Across Stroke Types and Ischemic Subtypes: Comprehensive Insights From Levine et al. (2025)

You described a problem but INCOMPETENTLY DIDN'T GIVE US A SOLUTION! You're fired!

Poststroke Cognitive Decline Across Stroke Types and Ischemic Subtypes: Comprehensive Insights From Levine et al. (2025)

Levine DA, Whitney RT, Ye W, Briceño EM, Gross AL, Giordani BJ, Sussman JB, Lazar RM, Howard VJ, Aparicio HJ, et al. Associations Between Stroke Type, Ischemic Stroke Subtypes, and Poststroke Cognitive Trajectories. Stroke. 2025;56:898–907.

Acute stroke is associated with accelerated, yearslong cognitive decline and dementia. A recent study by Levine et al. explores whether different types of strokes — ischemic or hemorrhagic — and subtypes of ischemic strokes are associated with varying patterns of cognitive decline after stroke. Using data pooled from four large U.S. cohort studies (ARIC, CHS, FOS, REGARDS) from 1971-2019, the researchers followed 1,143 dementia-free stroke survivors over a median of six years. They assessed changes in global cognition (primary outcome), executive function, and memory (secondary outcomes), and evaluated the impact of poststroke vascular risk factors (blood pressure, glucose, cholesterol) on these trajectories.

The study cohort was diverse, with nearly half being female and about 31% Black. Most of the strokes were ischemic (92.8%), with a smaller proportion being hemorrhagic (7.2%). Across the cohort, ischemic stroke survivors experienced annual declines in global cognition decline, executive function, and memory. However, the rate of cognitive decline did not significantly differ between ischemic and hemorrhagic stroke survivors, or among the ischemic stroke subtypes (cardioembolic, large artery atherosclerotic, lacunar/small vessel, and cryptogenic/other). Small vessel stroke survivors showed similar declines, with no significant differences compared to other subtypes. Adjusting for poststroke vascular risk factors did not meaningfully alter these associations.

Strengths of the study include its large, racially diverse sample, expert-adjudicated stroke classification, and harmonized cognitive assessments. However, limitations, such as the lack of data on stroke severity, imaging, and certain cognitive domains, as well as potential underestimation due to attrition, suggest that further research is needed. As stroke survivors increasingly live longer, identifying modifiable risk factors that influence cognitive outcomes remains a critical area for future research.(WOW! You're totally fucking wrong! Research is needed to prevent cognitive decline!)