Association of diabetes, homocysteine, and HDL with cognition and disability after stroke.
OBJECTIVE
To delineate factors associated with cognitive function following stroke and test the hypothesis that vascular risk factors associated with oxidative stress impair recovery.


METHODS
We performed a post hoc analysis of the extensive longitudinal database from the 3,680 subjects (over 35 years old) entered between 1996 and 2003 into the Vitamin Intervention for Stroke Prevention trial using a linear mixed effects model. The primary outcome variables were scores on the Mini-Mental State Examination (MMSE) and modified Rankin Scale (mRS).


RESULTS
MMSE and mRS gradually improved during the 2-year follow-up period. Increased age and nonwhite race, recurrent stroke, diabetes mellitus, left hemisphere cortical lesions, and values of high-density lipoprotein and homocysteine were independent predictors of less successful cognitive recovery. A strong interaction between homocysteine and age indicated a threshold effect beginning in the late 50s. No vitamin treatment effects were identified. Similar factors were identified for recovery of disability as assessed by the mRS, although there were qualitative and quantitative differences.


CONCLUSIONS
The finding that diabetes, high-density lipoprotein, and homocysteine predict poorer cognitive function and greater disability after stroke is consistent with the hypothesis that metabolic stress plays a significant role in the poststroke period.
Department of Neurology, Albert Einstein Medical Center, 5401 Old York Road, Suite 300, Philadelphia, PA 19141, USA. newmang@einstein.edu
George C
GC
Newman
Heejung
H
Bang
Syed I
SI
Hussain
James F
JF
Toole
D000368:Aged; D010054:Brief Psychiatric Rating Scale; D008076:Cholesterol, HDL / Q000378:metabolism*; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000378:metabolism* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism* / Q000523:psychology; D005260:Female; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000378:metabolism* / Q000523:psychology
D008076:Cholesterol, HDL; D006710:Homocysteine