. 2019 Dec 10;93(24):e2257-e2271.

doi: 10.1212/WNL.0000000000008612. Epub 2019 Nov 11.

Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups

Jessica W Lo¹, John D Crawford¹, David W Desmond¹, Olivier Godefroy¹, Hanna Jokinen¹, Simin Mahinrad¹, Hee-Joon Bae¹, Jae-Sung Lim¹, Sebastian Köhler¹, Elles Douven¹, Julie Staals¹, Christopher Chen¹, Xin Xu¹, Eddie J Chong¹, Rufus O Akinyemi¹, Rajesh N Kalaria¹, Adesola Ogunniyi¹, Mélanie Barbay¹, Martine Roussel¹, Byung-Chul Lee¹, Velandai K Srikanth¹, Christopher Moran¹, Nagaendran Kandiah¹, Russell J Chander¹, Behnam Sabayan¹, J Wouter Jukema¹, Susanna Melkas¹, Timo Erkinjuntti¹, Henry Brodaty¹, Régis Bordet¹, Stéphanie Bombois¹, Hilde Hénon¹, Darren M Lipnicki¹, Nicole A Kochan¹, Perminder S Sachdev²; Stroke and Cognition (STROKOG) Collaboration

Collaborators, Affiliations

Collaborators

Stroke and Cognition (STROKOG) Collaboration:
Amy Brodtmann, Aleksandra Klimkowicz- Mrowiec, Martin Dichgans, Michael Hoffmann, Thomas Linden, Joanna Wardlaw, Charlotte Cordonnier, Vincent Mok

Affiliations

¹ From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France.
² From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France. p.sachdev@unsw.edu.au.

PMID: 31712368
PMCID: PMC6937495
DOI: 10.1212/WNL.0000000000008612

Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups

Jessica W Lo et al. Neurology. 2019.

. 2019 Dec 10;93(24):e2257-e2271.

doi: 10.1212/WNL.0000000000008612. Epub 2019 Nov 11.

Authors

Collaborators

Stroke and Cognition (STROKOG) Collaboration:
Amy Brodtmann, Aleksandra Klimkowicz- Mrowiec, Martin Dichgans, Michael Hoffmann, Thomas Linden, Joanna Wardlaw, Charlotte Cordonnier, Vincent Mok

Affiliations

¹ From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France.
² From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France. p.sachdev@unsw.edu.au.

PMID: 31712368
PMCID: PMC6937495
DOI: 10.1212/WNL.0000000000008612

Abstract

Objective: To address the variability in prevalence estimates and inconsistencies in potential risk factors for poststroke cognitive impairment (PSCI) using a standardized approach and individual participant data (IPD) from international cohorts in the Stroke and Cognition Consortium (STROKOG) consortium.

Methods: We harmonized data from 13 studies based in 8 countries. Neuropsychological test scores 2 to 6 months after stroke or TIA and appropriate normative data were used to calculate standardized cognitive domain scores. Domain-specific impairment was based on percentile cutoffs from normative groups, and associations between domain scores and risk factors were examined with 1-stage IPD meta-analysis.

Results: In a combined sample of 3,146 participants admitted to hospital for stroke (97%) or TIA (3%), 44% were impaired in global cognition and 30% to 35% were impaired in individual domains 2 to 6 months after the index event. Diabetes mellitus and a history of stroke were strongly associated with poorer cognitive function after covariate adjustments; hypertension, smoking, and atrial fibrillation had weaker domain-specific associations. While there were no significant differences in domain impairment among ethnoracial groups, some interethnic differences were found in the effects of risk factors on cognition.

Conclusions: This study confirms the high prevalence of PSCI in diverse populations, highlights common risk factors, in particular diabetes mellitus, and points to ethnoracial differences that warrant attention in the development of prevention strategies.

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Figures

**Figure 1. Stacked bar chart showing the percentage of impairment in each domain in each study**
Each column does not add up to 100%. Impairment is based on the 6.68th percentile. COAST = Cognitive Outcome After Stroke; EpiUSA = Epidemiologic Study of the Risk of Dementia After Stroke; GRECogVASC = Groupe de Réflexion pour l'evaluation Cognitive Vasculaire Study; K-VCIHS = Korean-Vascular Cognitive Impairment Harmonization Standards Study; SAM = Helsinki Stroke Aging Memory Study; SSS = Sydney Stroke Study; VCI = Vascular Cognitive Impairment. *Studies with missing domain score. **Studies not included in the combined sample.

**Figure 2. Forest plots of effect of risk factors on cognitive function in global cognition**
These 2-stage meta-analyses were used to examine the degree of variability across studies. For pooled effect sizes (ESs), refer to results from the 1-stage meta-analyses presented in table 5 (for global cognition) and data available from Dryad (appendix T15, doi.org/10.5061/dryad.m517990, for results in the 5 domains). CASPER = Cognition and Affect After Stroke: Prospective Evaluation of Risks; CI = confidence interval; COAST = Cognitive Outcome After Stroke; COGFAST-Nigeria = Cognitive Function After Stroke Nigeria; EpiUSA = Epidemiologic Study of the Risk of Dementia After Stroke; GECOG-VASC = Groupe de Réflexion pour l'evaluation Cognitive Vasculaire Study; K-VCIHS = Korean-Vascular Cognitive Impairment Harmonization Standards Study; NEMESIS = North East Melbourne Stroke Incidence Study; NNI = National Neuroscience Institute Study; PROSPER = Prospective Study of Pravastatin in the Elderly at Risk; SAM = Helsinki Stroke Aging Memory Study; SSS = Sydney Stroke Study; STROKDEM = Study of Factors Influencing Post-Stroke Dementia; VCI = Vascular Cognitive Impairment.

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References

1. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol 2009;8:1006–1018. - PubMed
1. O'Brien JT, Erkinjuntti T, Reisberg B, et al. . Vascular cognitive impairment. Lancet Neurol 2003;2:89–98. - PubMed
1. Looi JC, Sachdev PS. Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 1999;53:670–678. - PubMed
1. Sachdev PS, Brodaty H, Valenzuela MJ, et al. . The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology 2004;62:912–919. - PubMed
1. Gottesman RF, Hills AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 2010;9:895–905. - PMC - PubMed

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Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups

Collaborators

Affiliations

Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical