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. 2022;89(2):745-754.
doi: 10.3233/JAD-220305.

Lifestyle and Cognitive Decline in Community-Dwelling Stroke Survivors

Klodian Dhana  1   2 , Neelum T Aggarwal  3   4 , Todd Beck  1   2 , Thomas M Holland  1   2 , Anisa Dhana  1   2 , Laurel J Cherian  4 , Pankaja Desai  1   2 , Denis A Evans  1   2 , Kumar B Rajan  1   2
Affiliations

Lifestyle and Cognitive Decline in Community-Dwelling Stroke Survivors

Klodian Dhana et al. J Alzheimers Dis. 2022.

Abstract

Background: Patients with stroke are at a higher risk of cognitive impairment and Alzheimer's disease dementia.

Objective: To quantify the role of lifestyle pre-stroke, post-stroke, and changes in lifestyle before and after stroke with cognitive decline in community-dwelling stroke survivors.

Methods: Utilizing data from the Chicago Health and Aging Project, a population-based cohort study, we studied 1,078 individuals with stroke (662 incident and 416 prevalent) who underwent cognitive testing during the study period. A healthy lifestyle score was defined by scoring four behaviors: non-smoking, exercising, being cognitively active, and having a high-quality diet. The global cognitive score was derived from a comprehensive battery of 4 standardized tests.

Results: The mean age at incident stroke was 78.2 years, and 60.1% were women. A healthy lifestyle pre-incident stroke was associated with a slower rate of cognitive decline after stroke. Participants with 3-4 healthy lifestyle factors pre-incident stroke had a slower cognitive decline after stroke by 0.046 units/year (95% CI 0.010, 0.083), or 47.7% slower, than participants with 0-1 healthy lifestyle factor. Lifestyle score post-prevalent stroke was not associated with cognitive decline. Changes in lifestyle behaviors from pre- to post-incident stroke were related to cognitive decline after stroke. Individuals who deteriorated their lifestyle quality after stroke had a faster cognitive decline by 0.051 units/year (β -0.051, 95% CI -0.090, -0.012) than participants with no change in lifestyle score.

Conclusion: A healthy lifestyle pre-stroke was associated with a slower rate of cognitive decline in stroke survivors, highlighting the importance of primary prevention. After the stroke, changes in lifestyle behaviors may influence the cognitive abilities of older adults as they age.

Keywords: Cognition; cognitive decline; cohort study; healthy lifestyle; stroke patients.

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Figures

Figure 1.
Figure 1.. Predicted 15-year rates (SE) of change in global cognition for a typical stroke survivor in Chicago Health and Aging Project.
(A) Trajectories of global cognition after stroke by lifestyle score pre-incident stroke. Participants with 0–1 low-risk lifestyle factors pre-incident stroke had a rate of cognitive decline by −0.097 units/year, and those with 3-4 low-risk factors had a rate of −0.051 units/year or 47.7% slower (p=0.01). (B) Trajectories of global cognition by lifestyle score post-prevalent stroke. Participants with 0–1 low-risk lifestyle factors post-prevalent stroke had a rate of cognitive decline by −0.071 units/year, and those with 3-4 low-risk factors had a rate of −0.066 units/year or 7.5% slower (p=0.83). (C) Trajectories of global cognition by changes in lifestyle score before and after incident stroke. Participants with 0-1 low-risk lifestyle factors and no changes in lifestyle score before and after incident stroke had a rate of cognitive change of −0.108 units/year, and those who decreased the lifestyle score (range: −3 to −1) had a rate of −0.159 units/year or 47.1% faster (p=0.01).
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