Associations Between Stroke Type, Ischemic Stroke Subtypes, and Poststroke Cognitive Trajectories.

IF 8.9 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2025-04-01 Epub Date: 2025-03-10 DOI:10.1161/STROKEAHA.124.047640

Deborah A Levine, Rachael T Whitney, Wen Ye, Emily M Briceño, Alden L Gross, Bruno J Giordani, Jeremy B Sussman, Ronald M Lazar, Virginia J Howard, Hugo J Aparicio, Alexa S Beiser, Mitchell S V Elkind, Rebecca F Gottesman, Silvia Koton, Sarah T Pendlebury, Adam S Kollipara, Mellanie V Springer, Sudha Seshadri, Jose R Romero, Annette L Fitzpatrick, W T Longstreth, Rodney A Hayward

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Abstract

Background: It is unclear how poststroke cognitive trajectories differ by stroke type and ischemic stroke subtype. We studied associations between stroke types (ischemic and hemorrhagic), ischemic stroke subtypes (cardioembolic, large artery atherosclerotic, lacunar/small vessel, and cryptogenic/other determined causes), and poststroke cognitive decline.

Methods: We pooled participants from 4 US cohort studies (1971-2019). Outcomes were change in global cognition (primary) and changes in executive function and memory (secondary). Outcomes were standardized as T scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1 SD difference in cognition. The median follow-up for the primary outcome was 6.0 (interquartile range, 3.2-9.2) years. Linear mixed-effects models estimated changes in cognition after stroke.

Results: We identified 1143 dementia-free individuals with acute stroke during follow-up: 1061 (92.8%) ischemic, 82 (7.2%) hemorrhagic, 49.9% female, and 30.8% Black. The median age at stroke was 74.1 (interquartile range, 68.6-79.3) years. On average, ischemic stroke survivors showed declines in global cognition (-0.35 [95% CI, -0.43 to -0.27] points/y; P<0.001), executive function (-0.48 [95% CI, -0.59 to -0.36] points/y; P<0.001), and memory (-0.27 [95% CI, -0.36 to -0.19] points/y; P<0.001). Poststroke declines in global cognition, executive function, and memory did not differ between hemorrhagic and ischemic stroke survivors. Differences in poststroke cognitive slope between hemorrhagic and ischemic stroke survivors were global cognition (0.02 [95% CI, -0.21 to 0.26] points/y; P=0.85), executive function (-0.13 [95% CI, -0.48 to 0.23] points/y; P=0.48), and memory (0.19 [95% CI, -0.05 to 0.43] points/y; P=0.12). On average, small vessel stroke survivors showed declines in global cognition (-0.33 [95% CI, -0.49 to -0.16] points/y; P<0.001), executive function (-0.44 [95% CI, -0.68 to -0.19] points/y; P<0.001), and memory (-0.19 [95% CI, -0.35 to -0.03] points/y; P=0.02). Poststroke cognitive declines did not differ between small vessel survivors and survivors of other ischemic stroke subtypes.

Conclusions: Stroke survivors had cognitive decline in multiple domains. Declines did not differ by stroke type or ischemic stroke subtype.

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脑卒中类型、缺血性脑卒中亚型和脑卒中后认知轨迹之间的关系。

背景：目前尚不清楚脑卒中类型和缺血性脑卒中亚型对脑卒中后认知轨迹的影响。我们研究了脑卒中类型（缺血性和出血性）、缺血性脑卒中亚型（心脏栓塞、大动脉粥样硬化、腔隙/小血管和隐源性/其他确定原因）和脑卒中后认知能力下降之间的关系。方法：我们汇集了4项美国队列研究（1971-2019）的参与者。结果是整体认知的改变（主要）和执行功能和记忆的改变（次要）。结果标准化为T评分（mean [SD], 50 [10]）；1分的差异代表0.1个标准差的认知差异。主要结局的中位随访时间为6.0年（四分位数间距为3.2-9.2年）。线性混合效应模型估计中风后的认知变化。结果：在随访期间，我们确定了1143例无痴呆的急性卒中患者：1061例（92.8%）缺血性卒中，82例（7.2%）出血性卒中，49.9%为女性，30.8%为黑人。中风时的中位年龄为74.1岁（四分位数间距为68.6-79.3岁）。平均而言，缺血性卒中幸存者整体认知能力下降(-0.35 [95% CI, -0.43至-0.27]点/年；ppp =0.85)，执行功能(-0.13 [95% CI, -0.48至0.23]点/y；P=0.48)，记忆(0.19 [95% CI, -0.05 ~ 0.43]点/y；P = 0.12)。平均而言，小血管中风幸存者的整体认知能力下降(-0.33 [95% CI, -0.49至-0.16]点/年；购买力平价= 0.02)。卒中后认知能力下降在小血管幸存者和其他缺血性卒中亚型幸存者之间没有差异。结论：脑卒中幸存者在多个领域的认知能力下降。脑卒中类型和缺血性脑卒中亚型的下降没有差异。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.