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. 2018 Sep;25(9):1182-1188.
doi: 10.1111/ene.13684. Epub 2018 Jun 22.

Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis

Y Teuschl  1 , H Ihle-Hansen  2 , K Matz  1   3   4 , A Dachenhausen  1 , P Ratajczak  1 , J Tuomilehto  1   5 , M H Ursin  2 , G Hagberg  2 , B Thommessen  6 , A R Øksengård  2 , M Brainin  1 ; ASPIS Study Group
Affiliations

Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis

Y Teuschl et al. Eur J Neurol. 2018 Sep.

Abstract

Background and purpose: The aim of this pooled patient-level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post-stroke care for the prevention of cognitive decline after stroke.

Methods: This pooled patient-level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)-A, TMT-B and 10-words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention-to-treat (ITT) principle using different imputation approaches and one was based on complete cases.

Results: Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT-A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables.

Conclusion: We found indications that multidomain interventions compared with standard care can improve the scores in TMT-A at 1 year after stroke but not those for TMT-B or the 10-words test. These results have to be interpreted with caution due to the small number of patients.

Keywords: cognition; cognitive decline; lifestyle; multidomain intervention; pooled data analysis; post-stroke dementia; prevention; stroke.

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Figures

Figure 1
Figure 1
Flow chart of patients included in the pooled data analysis. FU, follow‐up; TIA, transient ischemic attack; TMT, trail making test.
See this image and copyright information in PMC

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