title: Trajectory of Cognitive Decline After Incident Stroke.
abstract: OBJECTIVE
  Cognitive decline is a major cause of disability in stroke survivors. The magnitude of survivors' cognitive changes after stroke is uncertain.
  
  
  OBJECTIVE
  To measure changes in cognitive function among survivors of incident stroke, controlling for their prestroke cognitive trajectories.
  
  
  METHODS
  Prospective study of 23,572 participants 45 years or older without baseline cognitive impairment from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, residing in the continental United States, enrolled 2003-2007 and followed up through March 31, 2013. Over a median follow-up of 6.1 years (interquartile range, 5.0-7.1 years), 515 participants survived expert-adjudicated incident stroke and 23,057 remained stroke free.
  
  
  METHODS
  Time-dependent incident stroke.
  
  
  METHODS
  The primary outcome was change in global cognition (Six-Item Screener [SIS], range, 0-6). Secondary outcomes were change in new learning (Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; range, 0-30), verbal memory (Word-List Delayed Recall; range, 0-10), and executive function (Animal Fluency Test; range, ≥0), and cognitive impairment (SIS score <5 [impaired] vs ≥5 [unimpaired]). For all tests, higher scores indicate better performance.
  
  
  RESULTS
  Stroke was associated with acute decline in global cognition (0.10 points [95% CI, 0.04 to 0.17]), new learning (1.80 points [95% CI, 0.73 to 2.86]), and verbal memory (0.60 points [95% CI, 0.13 to 1.07]). Participants with stroke, compared with those without stroke, demonstrated faster declines in global cognition (0.06 points per year faster [95% CI, 0.03 to 0.08]) and executive function (0.63 points per year faster [95% CI, 0.12 to 1.15]), but not in new learning and verbal memory, compared with prestroke slopes. Among survivors, the difference in risk of cognitive impairment acutely after stroke, compared with immediately before stroke, was not statistically significant (odds ratio, 1.32 [95% CI, 0.95 to 1.83]; P = .10); however, there was a significantly faster poststroke rate of incident cognitive impairment compared with the prestroke rate (odds ratio, 1.23 per year [95% CI, 1.10 to 1.38]; P < .001). For a 70-year-old black woman with average values for all covariates at baseline, stroke at year 3 was associated with greater incident cognitive impairment: absolute difference of 4.0% (95% CI, -1.2% to 9.2%) at year 3 and 12.4% (95% CI, 7.7% to 17.1%) at year 6.
  
  
  CONCLUSIONS
  Incident stroke was associated with an acute decline in cognitive function and also accelerated and persistent cognitive decline over 6 years.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor2Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor4Department of.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor5Department of Biostatistics, University of Michigan, Ann Arbor.
authors.forename: Andrzej T
authors.initials: AT
authors.lastname: Galecki
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor2Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor6Institute for.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Department of Psychiatry, Indiana University of School of Medicine, Indianapolis.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Unverzagt
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor2Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Mohammed U
authors.initials: MU
authors.lastname: Kabeto
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
authors.affiliation: Department of Medicine, University of Alabama at Birmingham School of Medicine.
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007858:Learning; D016014:Linear Models; D008297:Male; D008569:Memory Disorders / Q000209:etiology*; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000523:psychology*