Associations Between Stroke Type, Ischemic Stroke Subtypes, and Poststroke Cognitive Trajectories
Year: 2025
Type: article
Abstract: Background: It is unclear how post-stroke cognitive trajectories differ by stroke type and ischemic stroke subtype. We studied associations between stroke types (ischemic, hemorrhagic), ischemic stroke subtypes (cardioembolic, large artery atherosclerotic, lacunar/small vessel, cryptogenic/other determined etiology), and post-stroke cognitive decline. Methods: This pooled cohort analysis from four US cohort studies (1971-2019) identified 1,143 dementia-free individuals with acute stroke during follow-up: 1,061 (92.8%) ischemic, 82 (7.2%) hemorrhagic, 49.9% female, 30.8% Black. Median age at stroke was 74.1 (IQR, 68.6, 79.3) years. Outcomes were change in global cognition (primary) and changes in executive function and memory (secondary). Outcomes were standardized as T-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Median follow-up for the primary outcome was 6.0 (IQR, 3.2, 9.2) years. Linear mixed-effects models estimated changes in cognition after stroke. Results: =0.82) after adjusting for demographics and pre-stroke cognition. On average, ischemic stroke survivors showed declines in global cognition, executive function, and memory. Post-stroke declines in global cognition, executive function, and memory did not differ between hemorrhagic and ischemic stroke survivors. 955 ischemic strokes had subtypes: 200 (20.9%) cardioembolic, 77 (8.1%) large artery atherosclerotic, 207 (21.7%) lacunar/small vessel, 471 (49.3%) cryptogenic/other determined etiology. On average, small vessel stroke survivors showed declines in global cognition and memory, but not executive function. Initial post-stroke cognitive scores and cognitive declines did not differ between small vessel survivors and survivors of other ischemic stroke subtypes. Post-stroke vascular risk factor levels did not attenuate associations. Conclusion: Stroke survivors had cognitive decline in multiple domains. Declines did not differ by stroke type or ischemic stroke subtype.
Source: Stroke
Authors: Deborah A. Levine, Rachael T. Whitney, Wen Ye, Emily M. Briceño, Alden L. Gross, Bruno J. Giordani, Jeremy B. Sussman, Ronald M. Lazar, Virginia J. Howard, Hugo J. Aparicio, Alexa S. Beiser, Mitchell S. V. Elkind, Rebecca F. Gottesman, Silvia Koton, Sarah T. Pendlebury, Adam S. Kollipara, Mellanie V. Springer, Sudha Seshadri, Jose R. Romero, Annette L. Fitzpatrick, William T. Longstreth, Rodney A. Hayward
Institutions: University of Michigan, Michigan Medicine, Johns Hopkins University, VA Ann Arbor Healthcare System, University of Alabama at Birmingham, UAB Medicine, Boston University, Columbia University, National Institute of Neurological Disorders and Stroke, Tel Aviv University, National Health Service, National Institute for Health and Care Research, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, The University of Texas at San Antonio, University of Washington
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: The Effect of Vascular Risk Factors on Risk of Alzheimer's Disease and Related Dementias after Stroke (STROKE COG), ARIC Neurocognitive Study (ARIC-NCS) Renewal UNC 4 of 5, The Effect of Vascular Risk Factors on Risk of Alzheimer's Disease and Related Dementias after Stroke (STROKE COG), ARIC Neurocognitive Study (ARIC-NCS) Renewal 2 of 5, ARIC Neurocognitive Study (ARIC-NCS), Michigan Center for Diabetes Translational Research, ARIC Neurocognitive Study (ARIC-NCS) Renewal 2023-2028, Infrastructure for mentored access to CHS data and specimens, Measurement of cognition and functional decline in Latinx older adults for detection of Alzheimer’s Disease and Related Dementias: A mixed-methods approach
OpenAlex ID: W4408276255