• Stroke · Apr 2018

    Risk Factors for Poststroke Cognitive Decline: The REGARDS Study (Reasons for Geographic and Racial Differences in Stroke).

    • Deborah A Levine, Virginia G Wadley, Kenneth M Langa, Frederick W Unverzagt, Mohammed U Kabeto, Bruno Giordani, George Howard, Virginia J Howard, Mary Cushman, Suzanne E Judd, and Andrzej T Galecki.
    • From the Department of Internal Medicine (D.A.L., K.M.L., M.U.K., A.T.G.) and Department of Psychiatry (B.G.), University of Michigan Medical School, Ann Arbor; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (D.A.L., K.M.L., M.U.K.); Institute for Healthcare Policy and Innovation (D.A.L., K.M.L.), Department of Neurology and Stroke Program (D.A.L.), Institute for Social Research (K.M.L.), and Department of Biostatistics (A.T.G.), University of Michigan, Ann Arbor; Department of Medicine (V.G.W.) and Department of Biostatistics (G.H., V.J.H., S.J.), University of Alabama School of Medicine, Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); and Department of Medicine, University of Vermont College of Medicine, Burlington (M.C.). deblevin@umich.edu.
    • Stroke. 2018 Apr 1; 49 (4): 987-994.

    Background And PurposePoststroke cognitive decline causes disability. Risk factors for poststroke cognitive decline independent of survivors' prestroke cognitive trajectories are uncertain.MethodsAmong 22 875 participants aged ≥45 years without baseline cognitive impairment from the REGARDS cohort (Reasons for Geographic and Racial Differences in Stroke), enrolled from 2003 to 2007 and followed through September 2015, we measured the effect of incident stroke (n=694) on changes in cognitive functions and cognitive impairment (Six-Item Screener score <5) and tested whether patient factors modified the effect. Median follow-up was 8.2 years.ResultsIncident stroke was associated with acute declines in global cognition, new learning, verbal memory, and executive function. Acute declines in global cognition after stroke were greater in survivors who were black (P=0.04), men (P=0.04), and had cardioembolic (P=0.001) or large artery stroke (P=0.001). Acute declines in executive function after stroke were greater in survivors who had ConclusionsIncident stroke alters a patient's cognitive trajectory, and this effect is greater with increasing age and cardioembolic stroke. Race, sex, geography, and hypertension status may modify the risk of poststroke cognitive decline.© 2018 American Heart Association, Inc.

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