Abstract T MP61: Cognitive Impairment and Incident Stroke: A Systematic Review and Meta-analysis
Background: Cognitive impairment may be associated with future stroke risk, but results of published studies have been inconsistent.
Objective: To clarify the qualitative and quantitative relationship of cognitive impairment to incident stroke.
Methods: We conducted a systematic search of PUBMED and EMBASE from 1947 to February 2013. Inclusion criteria were cohort studies, cognitive function evaluations at baseline, incident stroke ascertainment, follow-ups of at least 1 year, and reporting of quantitative estimates of multivariate adjusted relative risk (RR) and 95% confidence interval (CI) or standard error for stroke associated with cognitive impairment. Two independent reviewers extracted data. Estimates were combined using a random effects model.
Results: We identified 16 cohort studies with 119,720 participants and 7,688 stroke events. Nine studies used the Mini-Mental State Examination (MMSE) to assess cognitive function, while 7 studies used other cognitive measures. Incident stroke increased among people with baseline cognitive impairment (RR 1.36, 95% CI 1.21 to 1.53, P < 0.001), but significant heterogeneity existed (I2=83%, P< 0.001) (Table). Stratified analysis showed severe cognitive impairment was associated with higher incident stroke risk than mild cognitive impairment (RR 1.55, 95% CI 1.35 to 1.76 vs. RR 1.22, 95% CI 1.13 to 1.31, P for heterogeneity among groups = 0.002), which likely contributed to the heterogeneity among studies.
Conclusions: Baseline cognitive impairment is associated with a higher risk of incident stroke, even among people with mild cognitive impairment. Cognitive impairment should be more broadly recognized as a possible early clinical manifestation of vascular brain injury, so timely vascular risk factor management can be instituted to potentially avert future strokes and avoid further deterioration of cognitive health.
Author Disclosures: M. Lee: None. J.L. Saver: None. K. Hong: None. Y. Wu: None. H. Liu: None. B. Ovbiagele: None.
- © 2014 by American Heart Association, Inc.