Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 1;7(10):e2437133.
doi: 10.1001/jamanetworkopen.2024.37133.

Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts

Jessica W Lo  1 , John D Crawford  1 , Darren M Lipnicki  1 , Richard B Lipton  2 , Mindy J Katz  2 , Pierre-Marie Preux  3 , Maëlenn Guerchet  3   4 , Eleonora d'Orsi  5 , Anna Quialheiro  6 , Cassiano Ricardo Rech  7 , Karen Ritchie  8 , Ingmar Skoog  9   10 , Jenna Najar  9   11   12 , Therese Rydberg Sterner  13   14 , Elena Rolandi  15   16 , Annalisa Davin  15 , Michele Rossi  15 , Steffi G Riedel-Heller  17 , Alexander Pabst  17 , Susanne Röhr  17   18   19 , Mary Ganguli  20 , Erin Jacobsen  21 , Beth E Snitz  22 , Kaarin J Anstey  23   24   25 , Allison E Aiello  26 , Henry Brodaty  1 , Nicole A Kochan  1 , Yen-Ching Chen  27   28 , Jen-Hau Chen  29   30 , Pascual Sanchez-Juan  31 , Teodoro Del Ser  31 , Meritxell Valentí  31 , Antonio Lobo  32   33   34 , Concepción De-la-Cámara  32   33   34 , Elena Lobo  32   33   35 , Perminder S Sachdev  1
Affiliations

Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts

Jessica W Lo et al. JAMA Netw Open. .

Abstract

Importance: Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear.

Objective: To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajectory prestroke in stroke survivors with the trajectory of individuals without incident stroke over follow-up.

Design, setting, and participants: The study used harmonized and pooled data from 14 population-based cohort studies included in the Cohort Studies of Memory in an International Consortium collaboration. These studies were conducted from 1993 to 2019 across 11 countries among community-dwelling older adults without a history of stroke or dementia. For this study, linear mixed-effects models were used to estimate trajectories of cognitive function poststroke relative to a stroke-free cognitive trajectory. The full model adjusted for demographic and vascular risk factors. Data were analyzed from July 2022 to March 2024.

Exposure: Incident stroke.

Main outcomes and measures: The primary outcome was global cognition, defined as the standardized average of 4 cognitive domains (language, memory, processing speed, and executive function). Cognitive domain scores were formed by selecting the most commonly administered test within each domain and standardizing the scores.

Results: The study included 20 860 participants (12 261 [58.8%] female) with a mean (SD) age of 72.9 (8.0) years and follow-up of 7.51 (4.2) years. Incident stroke was associated with a substantial acute decline in global cognition (-0.25 SD; 95% CI, -0.33 to -0.17 SD), the Mini-Mental State Examination, and all cognitive domains (ranging from -0.17 SD to -0.22 SD), as well as accelerated decline in global cognition (-0.038 SD per year; 95% CI, -0.057 to -0.019 SD per year) and all domains except memory (ranging from -0.020 to -0.055 SD per year), relative to a stroke-free cognitive trajectory. There was no significant difference in prestroke slope in stroke survivors compared with the rate of decline in individuals without stroke in all cognitive measures. The mean rate of decline without a previous stroke was -0.049 SD per year (95% CI, -0.051 to -0.047 SD) in global cognition.

Conclusions and relevance: In this cohort study using pooled data from 14 cohorts, incident stroke was associated with acute and accelerated long-term cognitive decline in older stroke survivors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lo reported receiving grants from the Australian Government Research Training Program Scholarship during the conduct of the study. Dr Crawford reported receiving grants from the National Institutes of Health (NIH) to fund their position at UNSW. Dr Lipnicki reported receiving grants from NIH/National Institute on Aging (NIA) during the conduct of the study. Dr Lipton reported receiving personal fees from Abbvie (Allergan), American Academy of Neurology, American Headache Society, Amgen, Avanir, Axon, Axsome, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s (Promius), Electrocore, Eli Lilly, eNeura Therapeutics, Equinox, GlaxoSmithKline, Grifols, Lundbeck (Alder), Manistee, Merck, Pernix, Pfizer, Satsuma, Supernus, Teva, Trigemina, Vector, and Vedanta; grants from the US Food and Drug Administration, the Migraine Research Foundation, the National Headache Foundation, the NIH, and the NIA outside the submitted work. Dr Guerchet reported receiving grants from the French National Research Agency, AXA Research Fund, and Limoges University Hospital during the conduct of the study. Dr Skoog reported receiving grants from Swedish Research Council and Swedish Council for Working Life and Social Research during the conduct of the study. Dr Ganguli reported receiving grants from NIA during the conduct of the study. Dr Jacobsen reported grants from NIA at the NIH during the conduct of the study. Dr Anstey reported receiving personal fees from Roche outside the submitted work. Dr Brodaty reported receiving personal fees from Biogen, Eli Lilly, Eisai, Medicines Australia, Roche, Skin2Neuron, and Cranbrook Care outside the submitted work. Dr A. Lobo reported receiving grants from ZARADEMP Study: supported by grants from the Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain, and the Fondo Europeo de Desarrollo Regional (FEDER) of the European Union, and Gobierno de Aragón during the conduct of the study. Dr De-la-Cámara reported grants from Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, and FEDER of the European Union during the conduct of the study; personal fees from Almirall, Pfizer, Lilly, Esteve, Astrazeneca, Novartis, Lundbeck, Janssen, Casen Recordati, and Rovi outside the submitted work. Dr E. Lobo reported receiving grants from Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, FEDER of the European Union, and Gobierno de Aragón during the conduct of the study. Dr Sachdev reported receiving grants from the NIH and the National Health and Medical Research Council (NHMRC) Australia outside the submitted work; serving on the expert advisory committees of Biogen and Roche Australia in 2020 and 2021; and receiving speakder fees from Alkim Laboratories. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Projected Values of Global Cognition Among All Participants and in the Stroke and No-Stroke Groups
Projected values of global cognition were calculated for common values of covariates at baseline and for stroke occurring at 4.6 years into the study. Common values were based on subsample with global cognition data (see eTable 12 in Supplement 1). Plots of projected values with 95% CIs are shown in eFigure 4 in Supplement 1.
Figure 2.
Figure 2.. Projected Values of Cognitive Function in Each Domain and Mini-Mental State Examination (MMSE) Among All Participants
Projected values of cognition scores were calculated for common values of covariates at baseline and for stroke occurring at 4.6 years into the study. Common values were based on subsample with global cognition data (see eTable 14 in Supplement 1). Plots of predicted values with 95% CIs are shown in eFigure 5 in Supplement 1.
See this image and copyright information in PMC

Comment in

References

    1. Feigin VL, Brainin M, Norrving B, et al. . World Stroke Organization (WSO): global stroke fact sheet 2022. Int J Stroke. 2022;17(1):18-29. doi:10.1177/17474930211065917 - DOI - PubMed
    1. Lo JW, Crawford JD, Desmond DW, et al. ; Stroke and Cognition (STROKOG) Collaboration . Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019;93(24):e2257-e2271. doi:10.1212/WNL.0000000000008612 - DOI - PMC - PubMed
    1. Rost NS, Brodtmann A, Pase MP, et al. . Post-stroke cognitive impairment and dementia. Circ Res. 2022;130(8):1252-1271. doi:10.1161/CIRCRESAHA.122.319951 - DOI - PubMed
    1. Levine DA, Galecki AT, Langa KM, et al. . Trajectory of cognitive decline after incident stroke. JAMA. 2015;314(1):41-51. doi:10.1001/jama.2015.6968 - DOI - PMC - PubMed
    1. Zheng F, Yan L, Zhong B, Yang Z, Xie W. Progression of cognitive decline before and after incident stroke. Neurology. 2019;93(1):e20-e28. doi:10.1212/WNL.0000000000007716 - DOI - PubMed

Publication types