Abstract
The manifestation of cognitive and physical impairment in stroke patients before the acute event suggests accumulating subclinical vascular pathology in the brain. We investigated whether impairments in cognitive and physical functioning were associated with an increased stroke risk. Between 2002 and 2008, 8,519 stroke-free non-demented participants from the population-based Rotterdam Study underwent cognition and physical assessments including Mini-Mental State Examination, 15-word learning test, Stroop test, letter-digit substitution test, verbal fluency test, Purdue pegboard test and questionnaires on basic and instrumental activities of daily living (BADL; IADL). Principal component analysis was used to derive global cognition (G-factor). Incident stroke was assessed through continuous monitoring of medical records until 2016. Among 8,519 persons (mean age 66.0 years; 57.8% women), 489 suffered a stroke during mean follow-up of 8.7 years (SD: 2.9). Worse G-factor was associated with higher stroke risk (Hazard Ratio 1.21, 95% CI: 1.06–1.38), largely driven by unspecified stroke. Likewise, worse scores on 15-word learning test, Stroop test, Purdue pegboard test, IADL, and BADL were associated with higher risk of stroke. Thus both worse cognitive and physical functioning were associated with a higher stroke risk, in particular unspecified stroke and persons with worse memory, information processing, executive function, and motor function.
Highlights
Stroke is a leading cause of disability and mortality worldwide and its burden is expected to rise due to aging populations[1,2]
Lower G-factor at baseline showed a significant association with a higher risk of any stroke. Lower scores on both basic and instrumental activities of daily living (BADL) and IADL were significantly associated with an increased risk of any stroke
After additional censoring for incident dementia, the association between G-factor and any stroke was attenuated whereas the associations between both activities of daily living (ADL) scores and any stroke remained present
Summary
Stroke is a leading cause of disability and mortality worldwide and its burden is expected to rise due to aging populations[1,2]. Cognitive and physical deterioration are suggested to represent early manifestations of accumulating subclinical vascular pathology in the brain prior to the acute event. Previous studies have linked impairments in global cognitive and physical functioning with an increased risk of stroke[5,7,8]. Earlier studies have generally relied on global markers of cognitive and physical functioning or used a limited number of tests that do not represent all domains[5,10,11,12]. We investigated whether impairments in different domains of cognitive and physical functioning were associated with an increased risk of different stroke subtypes in community-dwelling individuals
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