Abstract
Objective: The aim of this study was to explore the longitudinal associations of stroke with cognitive impairment in older US adults.Method: The data used in this longitudinal analysis were extracted from the National Health and Aging Trends Study (NHATS) from 2011 to 2019. Univariate and multivariable Cox proportional hazards regression models were used to estimate the longitudinal association of stroke with cognitive impairment. The multivariable model was adjusted by demographic, physical, and mental characteristics, and the complex survey design of NHATS was taken into consideration.Results: A total of 7,052 participants with complete data were included. At the baseline, the weighted proportion of cognitive impairment was 19.37% (95% CI, 17.92–20.81%), and the weighted proportion of the history of stroke was 9.81% (95% CI, 8.90–10.72%). In univariate analysis, baseline stroke history was significantly associated with cognitive impairment in the future (hazard ratio, 1.746; 95% CI, 1.461–2.088), and the baseline cognitive impairment was significantly associated with future report of stroke (hazard ratio, 1.436; 95% CI, 1.088–1.896). In multivariable model, stroke was also significantly associated with cognitive impairment (hazard ratio, 1.241; 95% CI, 1.011–1.522); however, the reverse association was not significant (hazard ratio, 1.068; 95% CI, 0.788–1.447). After the data from proxy respondents were excluded, in the sensitive analyses, the results remained unchanged.Conclusion: Older adults in the United States who suffered strokes are more likely to develop cognitive impairment as a result in the future than those who have not had strokes. However, the reverse association did not hold. Furthermore, the study suggests that it is necessary to screen and take early intervention for cognitive impairment in stroke survivors and prevent the incidence of stroke by modifying risk factors in the general population with rapidly growing older US adults.
Highlights
Stroke, described as an interruption to the supply of blood to the brain by WHO [1], is one of the leading causes of death and disability in the United States [2]
We found that the cumulative proportion of not reporting cognitive impairment was significantly higher in respondents with nonstroke than those with stroke at the baseline (P < 0.0001)
Based on the representative sample of community-dwelling elders 65 years old from the National Health and Aging Trends Study (NHATS), our study found a significant association between baseline stroke and subsequent cognitive impairment incidence; and the reverse relation was not true after adjusting for potential confounders, the crude hazard ratio (HR) was significant
Summary
Stroke, described as an interruption to the supply of blood to the brain by WHO [1], is one of the leading causes of death and disability in the United States [2]. According to the results of 2015 Alzheimer’s Disease Facts and Figures, there is a dramatic growing trend of dementia, and the prevalence is estimated to be growing to nearly 15 million by 2050 in the United States [4]. Both stroke and dementia have posed a heavy burden on the health system and serious influence on economies in the United States [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
