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Cognitive performance after stroke--the Framingham Heart Study.

ABSTRACT: BACKGROUND:Individuals with a high risk of stroke are also more prone to cognitive impairment perhaps because of concomitant vascular risk factors. In addition, clinical stroke increases the risk of subsequent dementia. Nevertheless, the relationship between clinical stroke and subsequent cognitive function in initially nondemented individuals remains less clear as most prior studies examined case series without controls. AIMS:To specify among nondemented individuals the cognitive domains affected by clinical stroke, independently of vascular risk factors and prestroke cognition. METHODS:One hundred thirty-two Framingham study participants (mean age?=?77?±?9 years, 54% women) with prospectively validated initial strokes, as well as age- and gender-matched controls, underwent identical cognitive evaluations ?six-months after the stroke. Linear regression models were used to assess the differences in cognitive scores between stroke cases and controls adjusting for prestroke cognitive function as assessed by Mini-Mental State Examination scores, and with and without adjustment for vascular risk factors. RESULTS:Adjusting for prestroke cognition and vascular risk factors, persons with stroke had poorer cognitive function in the domains of immediate recall of logical and visual memories (??=?-1·27?±?0·60, P?=?0·035; ??=?-1·03?±?0·47, P?=?0·028, respectively), verbal learning (paired associate test; ??=?-1·31?±?0·57, P?=?0·023), language (Boston naming test; ??=?-0·27?±?0·08, P?=?0·002), executive function (digit span backward; ??=?-0·53?±?0·21, P?=?0·015), and visuospatial and motor skills (block design; ??=?-3·02?±?1·06, P?=?0·005). CONCLUSIONS:Clinical stroke is associated with subsequent poorer performance in multiple cognitive domains. This association cannot be entirely explained by the individual's cognitive function prior to stroke or by concomitant vascular risk factor levels.

SUBMITTER: Weinstein G

PROVIDER: S-EPMC4215163 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Cognitive performance after stroke--the Framingham Heart Study.

Weinstein Galit G Preis Sarah R SR Beiser Alexa S AS Au Rhoda R Kelly-Hayes Margaret M Kase Carlos S CS Wolf Philip A PA Seshadri Sudha S

International journal of stroke : official journal of the International Stroke Society 20140430

<h4>Background</h4>Individuals with a high risk of stroke are also more prone to cognitive impairment perhaps because of concomitant vascular risk factors. In addition, clinical stroke increases the risk of subsequent dementia. Nevertheless, the relationship between clinical stroke and subsequent cognitive function in initially nondemented individuals remains less clear as most prior studies examined case series without controls.<h4>Aims</h4>To specify among nondemented individuals the cognitive ...[more]

PMID: 25352473

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Project description:We compared the performance of FRAX according to frailty status in 3554 individuals from the Framingham Study. During 10-year follow-up, 6.9% and 3.0% of participants with and without frailty experienced MOF. Discrimination profiles were lower in participants with frailty compared to those without, but they improved when FRAX included BMD.IntroductionFrailty increases fracture risk. FRAX was developed to predict fractures but never validated in individuals with frailty. We aimed to compare the predictive performance of FRAX (v4.3) in individuals with and without frailty.MethodsWe conducted a cohort study using the Framingham Heart Study. Frailty was defined by the Fried phenotype. Major osteoporotic fractures (MOF) were ascertained from medical records during 10-year follow-up. To evaluate discrimination and calibration of FRAX, we calculated the area-under-the-receiver-operating characteristics curves (AUC) using logistic regression models and observed-to-predicted fracture probabilities. Analyses were stratified by frailty status.ResultsFrailty was present in 550/3554 (15.5%) of participants. Participants with frailty were older (81.1 vs. 67.6 years), female (68.6% vs. 55.1%), and had greater mean FRAX scores (MOF: 15.9% vs. 10.1%) than participants without frailty. During follow-up, 38 participants with frailty (6.9%) and 91 without (3.0%) had MOFs. The AUC for FRAX (without BMD) was lower in participants with frailty (0.584; 95% CI 0.504-0.663) compared to those without (0.695; 95% CI 0.649-0.741); p value = 0.02. Among participants with frailty, the AUC improved when FRAX included BMD (AUC 0.658, p value < 0.01). FRAX overestimated MOF risk, with larger overestimations in individuals without frailty. Performance of FRAX for hip fracture was similar.ConclusionFRAX may have been less able to identify frail individuals at risk for fracture, as compared with individuals without frailty, unless information on BMD is available. This suggests that BMD captures features important for fracture prediction in frail persons. Future fracture prediction models should be developed among persons with frailty.

Dataset Information

Cognitive performance after stroke--the Framingham Heart Study.

Publications

Cognitive performance after stroke--the Framingham Heart Study.

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