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Acceleration of cognitive decline occurs after incident stroke

Individuals who survive a stroke are more likely to experience severe decline in cognitive function following their stroke, along with accelerated and persistent cognitive decline in the 6 years following stroke, according to recently released data in JAMA.

“In this national cohort of black and white U.S. residents 45 years or older, incident stroke was associated with accelerated and persistent declines in global cognition and executive function, after accounting for individuals’ cognitive changes before and acutely after the event,” Deborah A. Levine, MD, MPH, Division of General Medicine, University of Michigan, and colleagues wrote.

Deborah A. Levine

To assess the change in cognitive function after incident stroke, Levine and colleagues evaluated data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Among the 23,572 participants, aged 45 years and older, 515 survived a stroke during the 6.1 year follow-up.

Cognitive function, learning capability, verbal memory and executive function were measured using the Six-Item Screener, Consortium to Establish a Registry for Alzheimer Disease Word-List Learning, Word-List Delayed Recall and the Animal Fluency Test.

Results demonstrated that acute decline in global cognition (0.1 points; 95% CI, 0.04-0.17), new learning (1.8 points; 95% CI, 0.73-2.86) and verbal memory (0.6 points; 95% CI, 0.13-1.07) were strongly associated with stroke.

Per year, faster declines in global cognition (0.06 points; 95% CI, 0.03-0.08) and executive function (0.63 points; 95% CI, 0.12-1.15) were seen in stroke survivors, compared with participants without stroke. No such association was seen with new learning or verbal memory.

No significant difference was seen in the rate of cognitive impairment directly before and after stroke. However, a significantly faster rate of cognitive impairment was seen poststroke, compared with prestroke (OR = 1.23 per year; 95% CI, 1.1-1.38).

Levine and colleagues noted that these results suggest that survivors should be monitored for cognitive function years after their stroke incident, not just right before and after hospital discharge, as is currently the standard.

“As adults increasingly survive stroke, cases of poststroke cognitive impairment will multiply. Given that poststroke cognitive impairment increases mortality, morbidity and health care costs, health systems and payers will need to develop cost-effective systems of care that will best manage the long-term needs and cognitive problems of this increasing and vulnerable stroke survivor population,” Levine and colleagues concluded. – by Casey Hower

Disclosure: Levine reports receiving consulting fees from AstraZeneca and the National Institute of Neurological Disorders and Stroke; receiving a grant from the Michigan Alzheimer’s Disease Center; and serving as a member of the program advisory committee for the Kaiser Permanente Northern California-University of California, San Francisco Stroke Prevention/Intervention Research Program. Please see the full study for a list of all other authors’ relevant financial disclosures.