on August 31, 2006
Published online before print August 31, 2006, doi: 10.1161/01.STR.0000239666.46828.d7
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Submitted on April 16, 2006
From the National Stroke Research Institute (V.K.S., G.A.D., A.G.T.), Heidelberg Heights, Melbourne; the Menzies Research Institute (V.K.S., S.J.Q.), University of Tasmania, Hobart; the Department of Medicine (V.K.S.), Monash Medical Centre, Monash University, Melbourne; the Departments of Medicine (G.A.D., A.G.T.) and Psychology (M.M.S.), University of Melbourne, Melbourne; the Department of Epidemiology and Preventive Medicine (A.G.T.), Monash University, Melbourne; and Austin Health (G.A.D., M.M.S., A.G.T.), Heidelberg, Melbourne, Australia. * To whom correspondence should be addressed. E-mail: velandai.srikanth{at}med.monash.edu.au.
Background and Purpose--There are few data on long-term cognitive outcomes after first-ever stroke. We aimed to study long-term cognitive transitions, rates of cognitive change, and factors associated with incident dementia and cognitive impairment-no dementia (CIND) 2 years after first-ever stroke. Methods--A population-based cohort of incident first-ever stroke cases (n=99; mean age, 69.9 years) and an age- and sex-matched comparison group (nonstrokes, n=99) were followed up for 2 years by 3 serial examinations. Rates of cognitive change were compared by repeated-measures analyses. Factors associated with incident dementia and CIND at 2 years were determined by multinomial logistic regression. Results--Significant strokextime interactions were present for all cognitive domains, with stroke cases showing a greater rate of decline compared with nonstrokes. Stroke recurrence during follow-up was responsible for significantly greater global decline. Strokes with recurrence (P=0.02), age (P=0.004), and baseline cognitive impairment (P<0.001) were independently associated with incident dementia at 2 years. Strokes without recurrence (P=0.008), age (P=0.001), and baseline cognitive impairment (P<0.001) were independently associated with CIND at 2 years. Conclusions--Recurrent stroke contributes importantly to global cognitive decline after a first-ever stroke. Secondary stroke prevention will be important in ameliorating dementia related to stroke. Mechanisms underlying the progression of early cognitive impairment to dementia in stroke patients need further investigation.
Revised on June 19, 2006
Accepted on July 11, 2006
Long-Term Cognitive Transitions, Rates of Cognitive Change, and Predictors of Incident Dementia in a Population-Based First-Ever Stroke Cohort
Velandai K. Srikanth PhD*;
Key words: aging • dementia • epidemiology • stroke • vascular cognitive impairment
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