Abstract
Objective: Although stroke’s short-term cognitive effects are known, less is known about long-term cognitive changes after stroke. We determined changes in cognitive function among survivors of incident stroke, controlling for prestroke cognition. Methods: REasons for Geographic And Racial Differences in Stroke participants aged 45-84 years were recruited from 2003-2007 and followed through March 2013. Cognitive function was assessed every 18-24 months with the Consortium to Establish a Registry for Alzheimer’s Disease Word List Delayed Recall (WLD), a verbal memory test, and the Animal Fluency Test (AFT) of executive function. Adults with cognitive impairment (Six Item Screener <5) or incident stroke before their first WLD or AFT test were excluded. We examined changes in cognitive function over time, adjusting for time-varying incident stroke and initial values of cognitive scores, socio-demographics, vascular risk factors, and clinical factors using linear mixed effects models. Results: There were 10,665 adults with ≥1 follow-up WLD measure, of whom 190 had incident stroke, and 11,909 with ≥1 follow-up AFT measure, of whom 213 had incident stroke. Participants with incident stroke had acute decreases in WLD scores (adjusted decrease for incident stroke vs. no stroke, 1.58 points; 95% CI, 0.90-2.27 points) and AFT scores (adjusted decrease, 0.78 points; 95% CI, 0.23-1.33 points)(Figure). Following stroke, WLD scores improved over time (adjusted improvement, 0.24 points per year; 95% CI, 0.07-0.40; P for stroke*time interaction=0.005) but AFT scores did not change significantly (P for stroke*time interaction=0.91) compared with pre-stroke slopes. Conclusion: In this prospective population-based cohort, incident stroke was associated with significant new deficits in verbal memory and executive function and a new slope for verbal memory. These findings suggest that verbal memory recovers years after stroke, but executive function deficits persist.
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