Abstract TMP114: Exploring the Role of Cognitive Function in Secondary Stroke Prevention: Evidence from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) Study

Abstract

Studies suggest that cognitive impairment is common, even following mild stroke. Yet, secondary prevention strategies typically do not take into account patients’ cognitive functioning. Data from DESERVE, a secondary stroke prevention trial, were used to investigate relationships between cognition 6 months post-stroke and changes in medication adherence (MA) and total cholesterol (TC) between baseline and 12-month follow-up among mild/moderate stroke and TIA patients. Patients with any documented history of cognitive impairment and those unable to provide informed consent were excluded from the study. At six months, cognition was measured using three cognitively focused variables from the Stroke Impact Scale: Concentration, Remember Things Told to You (‘Memory’) and Orientation in Time. Items were scored from 1 to 5, with 1-3 = severe impairment, 4 = mild impairment, and 5 = no impairment. MA was measured using the 8-item Morisky Medication Adherence Scale. ANCOVA models were used to analyze associations between cognition and changes in MA and TC, and association between MA and TC, adjusting for key socio-demographic and clinical characteristics and intervention status. The analytic sample (n=396) was 48% male, 27% white, 32% black, 35% Hispanic, with mean age 64. Impairment in Memory was 13.4% severe, 13.6% mild, 44.7% none. In fully adjusted models, patients who were severely impaired in Memory, showed less improvement in MA compared to mild and no impairment: 0.3 vs. 0.2 vs 1.3 points (p<0.001, n=275), respectively. There was a U-shape trend relationship between cognitive status and cholesterol change, with no impairment performing best, mild performing worst, and moderate in between (decreases of 27.6 vs 13.1 vs 30.7 mg/dl; p=0.104, n=278 in Memory). The other cognitive domains showed similar relationships in both MA and TC. Cognition was thus related to MA, and MA in turn directly related to TC (b=-7.5, p<0.001, n=223). This is one of the first studies to identify post-stroke cognitive impairment as a potential barrier to effective secondary stroke prevention.