This article is more than 5 years old. Information may no longer be current.
Cognitive impairment increased future stroke risk
Results from a recent systematic review and meta-analysis indicated an association between cognitive impairment at baseline assessment and increased risk for future stroke, particularly fatal and ischemic stroke.
Researchers evaluated data on 7,799 stroke events occurring in 121,879 patients across 18 cohort studies collected from a search of Medline and Embase. All included studies assessed the cognitive function of participants at baseline, and stroke outcomes during an intended follow-up period of 1 year or longer (range 2.6-21 years). The primary outcome was risk for future stroke among patients with cognitive impairment.
Analysis of pooled data from all included studies indicated an increased risk for stroke among patients with baseline cognitive impairment (RR=1.39; 95% CI, 1.24-1.56), with a high degree of heterogeneity (I2=82%). Assessment of three trials with the maximal adjustment for potential confounders upheld the link between cognitive impairment and risk for future stroke, with no heterogeneity observed (RR=1.28; 95% CI, 1.18-1.38). Similar results were observed when analysis was limited to 10 studies that defined cognitive impairment according to a Mini-Mental State Examination score <25 or the nearest equivalent (RR=1.64; 95% CI, 1.46-1.84).
Sensitivity analyses omitting each study individually in turn and excluding studies that incorporated stroke outcomes other than total stroke did not significantly affect results. The researchers also noted that the observed risk increase was present for both fatal stroke (RR=1.68; 95% CI, 1.21-2.33 across three studies) and ischemic stroke (RR=1.65; 95% CI, 1.41-1.93 across four studies), specifically among patients with cognitive impairment at baseline. No association was observed for nonfatal stroke (RR=0.71; 95% CI, 0.25-2.01 across two studies) or hemorrhagic stroke (RR=0.57; 95% CI, 0.2-1.57 across two studies).
“Cognitive impairment should be more broadly recognized as a possible early clinical manifestation of cerebral infarction, so that timely management of vascular risk factors can be instituted to potentially prevent future stroke events and to avoid further deterioration of cognitive health,” the researchers concluded.
Disclosure: See the full study for a list of relevant financial disclosures.