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Original Article

Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study

  1. Virginia G. Wadley PhD1,*,
  2. Frederick W. Unverzagt PhD2,
  3. Lisa C. McGuire PhD3,
  4. Claudia S. Moy PhD4,
  5. Rodney Go PhD5,
  6. Brett Kissela MD6,
  7. Leslie A. McClure PhD7,
  8. Michael Crowe PhD8,
  9. Virginia J. Howard PhD5,
  10. George Howard DrPH7

Article first published online: 26 MAY 2011

DOI: 10.1002/ana.22432

Issue

Annals of Neurology

Annals of Neurology

Volume 70, Issue 2, pages 229–236, August 2011

Additional Information

How to Cite

Wadley, V. G., Unverzagt, F. W., McGuire, L. C., Moy, C. S., Go, R., Kissela, B., McClure, L. A., Crowe, M., Howard, V. J. and Howard, G. (2011), Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study. Ann Neurol., 70: 229–236. doi: 10.1002/ana.22432

Author Information

  1. 1

    Department of Medicine, University of Alabama at Birmingham, Birmingham, AL

  2. 2

    Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN

  3. 3

    Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA

  4. 4

    National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

  5. 5

    Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL

  6. 6

    Department of Neurology, University of Cincinnati, Cincinnati, OH

  7. 7

    Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL

  8. 8

    Department of Psychology, University of Alabama at Birmingham, Birmingham, AL

*University of Alabama at Birmingham, CH19 218T, Birmingham, AL 35294-2041

Publication History

  1. Issue published online: 5 AUG 2011
  2. Article first published online: 26 MAY 2011
  3. Accepted manuscript online: 28 MAR 2011 02:06PM EST
  4. Manuscript Accepted: 18 MAR 2011
  5. Manuscript Revised: 16 MAR 2011
  6. Manuscript Received: 13 FEB 2011

Funded by

  • National Institute of Neurological Disorders and Stroke, NIH, Department of Health and Human Services. Grant Number: U01 NS041588
  • Centers for Disease Control and Prevention's Healthy Aging Program

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Abstract

Objective:

To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States.

Methods:

A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments.

Results:

A total of 1,937 participants (8.1%) declined to an SIS score ≤4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07–1.30). All demographic factors and time independently predicted impairment.

Interpretation:

Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt. ANN NEUROL 2011

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