title: Global cognitive function before, surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors.
abstract: An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65-79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p's <.0.0001), but were not significantly different from the contrasting level (all p's >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.
authors.affiliation: a Department of Social Sciences and Health Policy , Wake Forest School of Medicine , Winston Salem , NC , 27157 , USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Vaughan
authors.affiliation: b Department of Neurology , Wake Forest School of Medicine , Winston-Salem , NC , 27157 , USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bushnell
authors.affiliation: c Department of Geriatric Medicine , University of Hawaii , Honolulu , HI 96817 , USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Bell
authors.affiliation: d Department of Biostatistical Sciences , Wake Forest School of Medicine , Winston-Salem , NC , 27157 , USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D016014:Linear Models; D008137:Longitudinal Studies; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D000067656:Optimism; D065840:Protective Factors; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*
keywords: aging; global cognitive function; ischemic; longitudinal; stroke