title: Cognitive status, stroke symptom reports, and modifiable risk factors among individuals with no diagnosis of stroke or transient ischemic attack in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
abstract: OBJECTIVE
  Vascular disorders that increase risk for stroke may be accompanied by decrements in cognitive functioning and by stroke symptoms in the absence of diagnosed stroke or transient ischemic attack. This study evaluates relationships among cognitive status, stroke symptom reports, and cardiovascular and behavioral factors.
  
  
  METHODS
  REasons for Geographic and Racial Differences in Stroke (REGARDS), a prospective population study of stroke incidence, assesses stroke risk with telephone interviews and in-home physicals. Excluding subjects with a history of stroke or transient ischemic attack, this analysis includes 14,566 black and white men and women > or =45 years of age. Incremental logistic models examine baseline relationships among cognitive status (Six-item Screener scores), stroke symptom reports, demographics, health behaviors, cardiovascular indices, and depressive symptoms.
  
  
  RESULTS
  A history of stroke symptoms was related to impaired cognitive status after adjusting for age, gender, race, and education but not after adjusting for poor health behaviors, vascular risk factors, and depressive symptoms. Odds of experiencing a stroke symptom increased 35% with each of five modifiable factors (hypertension, diabetes, smoking, lack of exercise, depressive symptoms), and odds of cognitive impairment increased an additional 12% with each modifiable factor. Lifelong abstinence from alcohol, lack of exercise, and depressive symptoms were independently related to impaired cognitive status.
  
  
  CONCLUSIONS
  The increased likelihood of cognitive impairment among subjects reporting stroke symptoms in the absence of a diagnosed stroke or transient ischemic attack suggests that such symptoms are not benign and may warrant clinical evaluation that includes a cognitive assessment. Future studies that include brain imaging may clarify the etiology of these symptoms.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA. vwadley@uab.edu
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Unverzagt
authors.forename: Rodney C
authors.initials: RC
authors.lastname: Go
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Moy
authors.forename: Martha R
authors.initials: MR
authors.lastname: Crowther
authors.forename: Camilo R
authors.initials: CR
authors.lastname: Gomez
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D017677:Age Distribution; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010809:Physical Fitness / Q000523:psychology; D044469:Racial Groups; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology