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(Stroke. 2007;38:1143.)
© 2007 American Heart Association, Inc.

Original Contributions

Cognitive Status, Stroke Symptom Reports, and Modifiable Risk Factors Among Individuals With No Diagnosis of Stroke or Transient Ischemic Attack in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Virginia G. Wadley, PhD; Leslie A. McClure, PhD; Virginia J. Howard, MSPH; Frederick W. Unverzagt, PhD; Rodney C. Go, PhD; Claudia S. Moy, PhD; Martha R. Crowther, PhD; Camilo R. Gomez, MD George Howard, DrPH

From the Departments of Medicine (V.G.W.), Biostatistics (L.A.M., G.H.), Epidemiology (V.J.H., R.C.G.), and Health Behavior (M.R.C.), University of Alabama at Birmingham, Ala; the Department of Psychiatry (F.W.U.), Indiana University School of Medicine, Indianapolis, Ind; the National Institute of Neurological Disorders and Stroke, National Institutes of Health (C.S.M.), Bethesda, Md; and Alabama Neurological Institute (C.R.G.), Birmingham, Ala.

Correspondence to Virginia G. Wadley, PhD, Assistant Professor of Medicine, Division of Gerontology and Geriatric Medicine, CH19 218T, University of Alabama at Birmingham, 1530 3rd Ave South, Birmingham, AL 35294-2041. E-mail vwadley{at}uab.edu

Background and Purpose— Vascular disorders that increase risk for stroke may be accompanied by decrements in cognitive functioning and by stroke symptoms in the absence of diagnosed stroke or transient ischemic attack. This study evaluates relationships among cognitive status, stroke symptom reports, and cardiovascular and behavioral factors.

Methods— REasons for Geographic and Racial Differences in Stroke (REGARDS), a prospective population study of stroke incidence, assesses stroke risk with telephone interviews and in-home physicals. Excluding subjects with a history of stroke or transient ischemic attack, this analysis includes 14 566 black and white men and women 45 years of age. Incremental logistic models examine baseline relationships among cognitive status (Six-item Screener scores), stroke symptom reports, demographics, health behaviors, cardiovascular indices, and depressive symptoms.

Results— A history of stroke symptoms was related to impaired cognitive status after adjusting for age, gender, race, and education but not after adjusting for poor health behaviors, vascular risk factors, and depressive symptoms. Odds of experiencing a stroke symptom increased 35% with each of five modifiable factors (hypertension, diabetes, smoking, lack of exercise, depressive symptoms), and odds of cognitive impairment increased an additional 12% with each modifiable factor. Lifelong abstinence from alcohol, lack of exercise, and depressive symptoms were independently related to impaired cognitive status.

Conclusions— The increased likelihood of cognitive impairment among subjects reporting stroke symptoms in the absence of a diagnosed stroke or transient ischemic attack suggests that such symptoms are not benign and may warrant clinical evaluation that includes a cognitive assessment. Future studies that include brain imaging may clarify the etiology of these symptoms.

Key Words: cardiovascular disease • cognition • depression • risk factors • stroke

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