Cognitive performance after stroke – The Framingham Heart Study

Authors

  • Galit Weinstein,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
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  • Sarah R. Preis,

    1. The Framingham Heart Study, Framingham, MA, USA
    2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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  • Alexa S. Beiser,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
    3. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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  • Rhoda Au,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
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  • Margaret Kelly-Hayes,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
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  • Carlos S. Kase,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
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  • Philip A. Wolf,

    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
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  • Sudha Seshadri

    Corresponding author
    1. Department of Neurology, Boston University School of Medicine, Framingham, MA, USA
    2. The Framingham Heart Study, Framingham, MA, USA
    • Correspondence: Sudha Seshadri*, Boston University School of Medicine, B602, 72 East Concord Street, Boston, MA 02118, USA.

      E-mail: suseshad@bu.edu

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  • Conflicts of interests: None declared.
  • Funding: This study was supported by National Institute of Neurological Disorders and Stroke (NS17950), the National Heart, Lung and Blood Association (HL93029, U01HL 096917), and the National Institute of Aging (AG08122, AG16495, AG033193, AG031287, P30AG013846).

Abstract

Background

Individuals with a high risk of stroke are also more prone to cognitive impairment perhaps because of concomitant vascular risk factors. In addition, clinical stroke increases the risk of subsequent dementia. Nevertheless, the relationship between clinical stroke and subsequent cognitive function in initially nondemented individuals remains less clear as most prior studies examined case series without controls.

Aims

To specify among nondemented individuals the cognitive domains affected by clinical stroke, independently of vascular risk factors and prestroke cognition.

Methods

One hundred thirty-two Framingham study participants (mean age = 77 ± 9 years, 54% women) with prospectively validated initial strokes, as well as age- and gender-matched controls, underwent identical cognitive evaluations ∼six-months after the stroke. Linear regression models were used to assess the differences in cognitive scores between stroke cases and controls adjusting for prestroke cognitive function as assessed by Mini-Mental State Examination scores, and with and without adjustment for vascular risk factors.

Results

Adjusting for prestroke cognition and vascular risk factors, persons with stroke had poorer cognitive function in the domains of immediate recall of logical and visual memories (β = −1·27 ± 0·60, P = 0·035; β = −1·03 ± 0·47, P = 0·028, respectively), verbal learning (paired associate test; β = −1·31 ± 0·57, P = 0·023), language (Boston naming test; β = −0·27 ± 0·08, P = 0·002), executive function (digit span backward; β = −0·53 ± 0·21, P = 0·015), and visuospatial and motor skills (block design; β = −3·02 ± 1·06, P = 0·005).

Conclusions

Clinical stroke is associated with subsequent poorer performance in multiple cognitive domains. This association cannot be entirely explained by the individual's cognitive function prior to stroke or by concomitant vascular risk factor levels.

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