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Li JX, Zhong QQ, Zhu T, Jin YL, Pan J, Yuan SX, Zhu F. Associations of cognitive impairment and longitudinal change in cognitive function with the risk of fatal stroke in middle-aged to older Chinese. Heliyon 2024; 10:e29353. [PMID: 38655351 PMCID: PMC11035061 DOI: 10.1016/j.heliyon.2024.e29353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
It is unclear whether cognitive impairment and the longitudinal change in cognition are associated with the risk of fatal stroke in aging populations. Based on the Guangzhou Biobank Cohort Study data a sum of 26,064 participants at baseline and all deaths caused by stroke in a mean follow-up of 14.3 years (standard deviation = 3.2) were included, and the Cox proportional hazard regression was used in this prospective cohort study. Cognitive impairment was respectively associated with an increased risk of fatal strokes (the adjusted hazard ratio (aHR) = 1.38, 95% CI1.16-1.64, P < 0.001) and fatal ischaemic stroke (aHR = 1.39, 95% CI1.10-1.77, P = 0.007), compared to median cognition; the Delayed Word Recall Test (DWRT) score was associated with a decreasing trend for the risk of fatal strokes in a restricted cubic spline analysis; the longitudinal DWRT score decline was associated with the increased risks of fatal strokes (aHR = 1.42, 95% CI 1.11-1.82, P = 0.006) and fatal haemorrhagic stroke (aHR = 1.75, 95% CI 1.10-2.78, P = 0.02), compared to the longitudinal DWRT score rise. In summary, cognitive impairment and the longitudinal decline in DWRT scores were associated with the increased risk of fatal strokes; early screening of cognitive function should be conducive to predictive intervention in fatal stroke among relatively healthy middle-aged to older populations.
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Affiliation(s)
- Jun-xiao Li
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Qiong-qiong Zhong
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Tong Zhu
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Ya-li Jin
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jing Pan
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Shi-xiang Yuan
- Department of Neurosurgery, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
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Qiao T, Lu H, Wang X, Wang X. Cognitive Impairment Is Associated with New-Onset Stroke: Evidence from a Nationwide Prospective Cohort Study. Cerebrovasc Dis 2023; 53:288-297. [PMID: 37729882 DOI: 10.1159/000533503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Stroke is closely related to cognitive function, and many patients experience cognitive impairment after stroke; however, whether cognitive impairment is associated with an increased risk of stroke remains inconclusive. This study aims to investigate whether cognitive impairment is associated with new-onset stroke (first ever nonfatal stroke) using a national prospective study. METHODS Data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 were used. A total of 11,961 Chinese participants aged ≥45 years without a history of stroke were included in the present study and divided into a cognitive impairment group and a normal group according to the baseline cognitive score. Logistic regression analysis was used to analyse the association between baseline cognitive function and new-onset stroke. RESULTS During the 6.96-year follow-up period, 875 participants experienced new-onset stroke. Compared with the cognitively normal group, the odds ratio (95% confidence intervals) for new-onset stroke in the cognitively impaired group was 1.21 (1.04, 1.40) when not adjusted for confounders and 1.22 (1.01, 1.48) after adjusting for established confounding factors, including demographic data, medical history, physical examination, and laboratory indicators. CONCLUSION Cognitive impairment was associated with new-onset stroke among middle-aged and elderly Chinese individuals. Further studies should be carried out to confirm the causal relationship between cognitive impairment and stroke.
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Affiliation(s)
- Tian Qiao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongzhuan Lu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xianghua Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Levine DA, Galecki AT, Morgenstern LB, Zahuranec DB, Langa KM, Kabeto MU, Okullo D, Nallamothu BK, Giordani B, Reale BK, Campbell M, Lisabeth LD. Preexisting Mild Cognitive Impairment, Dementia, and Receipt of Treatments for Acute Ischemic Stroke. Stroke 2021; 52:2134-2142. [PMID: 33902296 DOI: 10.1161/strokeaha.120.032258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status. METHODS Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. We compared receipt of a composite quality measure representing the percentage of 7 treatments/procedures received (ordinal scale; values, <0.75, 0.75-0.99, and 1.0), a binary defect-free quality score, and individual treatments after AIS between patients with preexisting dementia (Informant Questionnaire on Cognitive Decline in the Elderly score ≥3.44), mild cognitive impairment (MCI, score 3.1-3.43), and normal cognition (score ≤3). RESULTS Among patients with AIS, 42% had normal cognition (47% women; median age [interquartile range], 65 [56-76]), 32% had MCI (54% women; median age, 70 [60-78]), 26% had dementia (56% women; median age, 78 [64-85]). After AIS, 44% of patients with preexisting dementia and 55% of patients with preexisting MCI or normal cognition received defect-free care. Compared with cognitively normal patients, patients with preexisting MCI had similar cumulative odds (unadjusted cumulative odds ratio =0.99, P=0.92), and patients with preexisting dementia had 36% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio [OR]=0.64, P=0.005). However, the dementia-quality association became nonsignificant after adjusting for patient factors, namely sex, comorbidity, and body mass index (adjusted cumulative OR [acOR]=0.79, P=0.19). Independent of patient factors, preexisting MCI was negatively associated with receipt of IV tPA (intravenous tissue-type plasminogen activator; acOR=0.36, P=0.04), rehabilitation assessment (acOR=0.28, P=0.016), and echocardiogram (acOR=0.48, P<0.001). Preexisting dementia was negatively associated with receipt of antithrombotic by day 2 (acOR=0.39, P=0.04) and echocardiogram (acOR=0.42, P<0.001). CONCLUSIONS Patients with preexisting MCI and dementia, compared with cognitively normal patients, may receive less frequently some treatments and procedures, but not the composite quality measure, after AIS.
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Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor
| | - Andrzej T Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Department of Biostatistics (A.T.G.), University of Michigan, Ann Arbor
| | - Lewis B Morgenstern
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,Department of Epidemiology (L.B.M., L.D.L.), University of Michigan, Ann Arbor
| | - Darin B Zahuranec
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, MI (K.M.L., B.K.N.)
| | - Mohammed U Kabeto
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Dolorence Okullo
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Brahmajee K Nallamothu
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.A.L., L.B.M., K.M.L., B.K.N.), University of Michigan, Ann Arbor.,VA Ann Arbor Healthcare System, MI (K.M.L., B.K.N.)
| | - Bruno Giordani
- Department of Psychiatry and Michigan Alzheimer's Disease Center (B.G.), University of Michigan, Ann Arbor
| | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L., A.T.G., K.M.L., M.U.K., D.O., B.K.N., B.K.R.), University of Michigan, Ann Arbor
| | - Morgan Campbell
- Neuroscience Institute and Stroke Program Medical Director, Christus Spohn Shoreline, Corpus Christi, TX (M.C.)
| | - Lynda D Lisabeth
- Department of Neurology and Stroke Program (D.A.L., L.B.M., D.B.Z., L.D.L.), University of Michigan, Ann Arbor.,Department of Epidemiology (L.B.M., L.D.L.), University of Michigan, Ann Arbor
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Luksiene D, Sapranaviciute-Zabazlajeva L, Tamosiunas A, Radisauskas R, Bobak M. Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania. BMC Public Health 2021; 21:792. [PMID: 33894765 PMCID: PMC8070287 DOI: 10.1186/s12889-021-10843-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05). Conclusions The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.
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Affiliation(s)
- Dalia Luksiene
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania. .,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | | | - Abdonas Tamosiunas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
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Heshmatollah A, Mutlu U, Koudstaal PJ, Ikram MA, Ikram MK. Cognitive and physical impairment and the risk of stroke - A prospective cohort study. Sci Rep 2020; 10:6274. [PMID: 32286410 PMCID: PMC7156475 DOI: 10.1038/s41598-020-63295-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- A Heshmatollah
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - U Mutlu
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Wallin A, Kettunen P, Johansson PM, Jonsdottir IH, Nilsson C, Nilsson M, Eckerström M, Nordlund A, Nyberg L, Sunnerhagen KS, Svensson J, Terzis B, Wahlund LO, Georg Kuhn H. Cognitive medicine - a new approach in health care science. BMC Psychiatry 2018; 18:42. [PMID: 29422020 PMCID: PMC5806385 DOI: 10.1186/s12888-018-1615-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The challenges of today's society call for more knowledge about how to maintain all aspects of cognitive health, such as speed/attention, memory/learning, visuospatial ability, language, executive capacity and social cognition during the life course. MAIN TEXT Medical advances have improved treatments of numerous diseases, but the cognitive implications have not been sufficiently addressed. Disability induced by cognitive dysfunction is also a major issue in groups of patients not suffering from Alzheimer's disease or related disorders. Recent studies indicate that several negative lifestyle factors can contribute to the development of cognitive impairment, but intervention and prevention strategies have not been implemented. Disability due to cognitive failure among the workforce has become a major challenge. Globally, the changing aging pyramid results in increased prevalence of cognitive disorders, and the diversity of cultures influences the expression, manifestation and consequences of cognitive dysfunction. CONCLUSIONS Major tasks in the field of cognitive medicine are basic neuroscience research to uncover diverse disease mechanisms, determinations of the prevalence of cognitive dysfunction, health-economical evaluations, and intervention studies. Raising awareness for cognitive medicine as a clinical topic would also highlight the importance of specialized health care units for an integrative approach to the treatment of cognitive dysfunctions.
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Affiliation(s)
- Anders Wallin
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
| | - Petronella Kettunen
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden ,0000 0004 1936 8948grid.4991.5Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Per M. Johansson
- 0000 0000 9919 9582grid.8761.8Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H. Jonsdottir
- Institute for Stress Medicine, Region Västra Götaland, Gothenburg, Sweden ,0000 0000 9919 9582grid.8761.8Department of Food, Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Christer Nilsson
- 0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Michael Nilsson
- 0000 0000 8831 109Xgrid.266842.cUniversity of Newcastle, Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Marie Eckerström
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Arto Nordlund
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Lars Nyberg
- 0000 0001 1034 3451grid.12650.30Center for Functional Brain Imaging and Department of Radiation Sciences & Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Katharina S. Sunnerhagen
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Johan Svensson
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK ,0000 0004 0624 0275grid.413652.7Department of Endocrinology, Skaraborg Central Hospital, Skövde, Sweden
| | | | - Lars-Olof Wahlund
- 0000 0004 1937 0626grid.4714.6Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Solna, Sweden
| | - H. Georg Kuhn
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden ,0000 0001 2218 4662grid.6363.0Department of Neurology, Center for Stroke Research, Charité – Universitätsmedizin, Berlin, Germany
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