TOPLINE:

Elevated pre-stroke risk for atherosclerotic cardiovascular disease (ASCVD) was linked to worse cognitive outcomes in the decade after stroke, including faster global cognitive decline and an increased risk for dementia, a new study showed.

METHODOLOGY:

• A pooled analysis included more than 1800 adults with a history of stroke but no history of dementia (median age, 75 years; 52% female; 38% Black) from four prospective US cohort studies between 1971 and 2019.
• Cognitive tests were conducted with participants in person or by telephone in each cohort. The median post-stroke follow-up duration was 4.4 years for global cognition and 5.1 years for incident dementia.
• ASCVD was assessed using the American Heart Association PREVENT 10-year ASCVD risk equation, a sex-specific and race-free equation adjusted for age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, estimated glomerular filtration rate, use of antihypertensive and lipid-lowering medications, diabetes status, and current smoking status.
• Outcomes included changes in global cognition, executive function, and memory and the potential risk for dementia.

TAKEAWAY:

• Participants with higher pre-stroke ASCVD risk reported lower adjusted initial scores for post-stroke global cognition and faster cognitive decline (P < .0001 for both).
• Each 1% increase in the risk for pre-stroke ASCVD was associated with a 5% increase in the risk for 10-year post-stroke dementia (adjusted hazard ratio [HR], 1.05; P = .001), with stroke survivors in the highest ASCVD risk quintile more than twice as likely to develop dementia as those in the lowest quintile (HR, 2.57; P = .003).
• A higher risk for pre-stroke 10-year ASCVD was associated with lower initial post-stroke scores for executive function and memory (P < .0001 for both) but was not associated with declines over time.
• Stroke survivors in the highest pre-stroke ASCVD risk quintile were predicted to reach a decline of 0.5 SD in global cognition from baseline by 7.71 years after stroke compared with 17.75 years post-stroke for those in the lowest quintile, representing a clinically meaningful difference.

IN PRACTICE:

“These findings imply that intervening on vascular risk factors before stroke might lower post-stroke dementia risk, potentially by reducing stroke severity or other mechanisms,” the investigators of the study wrote.

SOURCE:

The study was led by Deborah A. Levine, MD, University of Michigan, Ann Arbor, Michigan. It was published online on June 8 in Neurology.

LIMITATIONS:

Details on stroke severity and location, brain imaging, subclinical infarcts, functional status, and other cognitive domains were unavailable. Different neuropsychological assessments were used across the cohort studies, which may have failed to capture subtle cognitive changes over time and/or limited the sample to healthy participants. Additional limitations included survivor bias, unmeasured confounders, and the selective attrition of cognitively impaired stroke survivors, which could have underestimated the rate of cognitive decline.

DISCLOSURES:

The study was funded by the National Institute on Aging (NIA), the National Institute of Neurological Disorders and Stroke (NINDS), the Alzheimer’s Association, the NIA Michigan Alzheimer’s Disease Research Center, the National Institute for Health and Care Research Oxford Biomedical Research Centre in the UK, and the NINDS Intramural Research Program; an American Academy of Neurology Career Development Award; and the Methods Core supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Disclosure information for the study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.