title: Long-term cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort.
abstract: OBJECTIVE
  There are few data on long-term cognitive outcomes after first-ever stroke. We aimed to study long-term cognitive transitions, rates of cognitive change, and factors associated with incident dementia and cognitive impairment-no dementia (CIND) 2 years after first-ever stroke.
  
  
  METHODS
  A population-based cohort of incident first-ever stroke cases (n=99; mean age, 69.9 years) and an age- and sex-matched comparison group (nonstrokes, n=99) were followed up for 2 years by 3 serial examinations. Rates of cognitive change were compared by repeated-measures analyses. Factors associated with incident dementia and CIND at 2 years were determined by multinomial logistic regression.
  
  
  RESULTS
  Significant stroke x time interactions were present for all cognitive domains, with stroke cases showing a greater rate of decline compared with nonstrokes. Stroke recurrence during follow-up was responsible for significantly greater global decline. Strokes with recurrence (P=0.02), age (P=0.004), and baseline cognitive impairment (P<0.001) were independently associated with incident dementia at 2 years. Strokes without recurrence (P=0.008), age (P=0.001), and baseline cognitive impairment (P<0.001) were independently associated with CIND at 2 years.
  
  
  CONCLUSIONS
  Recurrent stroke contributes importantly to global cognitive decline after a first-ever stroke. Secondary stroke prevention will be important in ameliorating dementia related to stroke. Mechanisms underlying the progression of early cognitive impairment to dementia in stroke patients need further investigation.
authors.affiliation: National Stroke Research Institute, Heidelberg Heights, Melbourne, Australia. velandai.srikanth@med.monash.edu.au
authors.forename: Velandai K
authors.initials: VK
authors.lastname: Srikanth
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Quinn
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.forename: Michael M
authors.initials: MM
authors.lastname: Saling
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012008:Recurrence; D020521:Stroke / Q000150:complications / Q000453:epidemiology*