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Tuesday, May 17, 2022

New research looking into risk factors for cognitive decline after stroke

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An international collaboration led by researchers from UNSW Sydney’s Centre for Healthy Brain Ageing (CHeBA) has offered new insights into what happens to cognitive function following a stroke and which risk factors lead to faster cognitive decline. 

It is currently estimated that one in four people globally will have a stroke in their lifetime, with more than 445,087 Australians currently living with the effects of stroke.

Although post stroke loss of cognitive ability is common, the trajectory and full extent of brain changes after stroke remains unclear.

Lead author and study coordinator of the Stroke and Cognition Consortium (STROKOG), Jess Lo, says the researchers wanted to find out how the cognitive performance of stroke survivors changes over time.

“STROKOG is an international collaboration which brings together post-stroke cohort studies,” Lo says.

“By performing analyses on combined datasets, this collaboration sets out to better understand the determinants of cognitive decline and dementia after stroke, as well as improve the diagnosis and treatment of post-stroke cognitive disorders.

“In this study we wanted to learn whether brain function declines rapidly at a steady state soon after having a stroke.”

The traditional focus in stroke rehabilitation has been on physical recovery and speech therapy, and cognitive function has been relatively neglected. This work provides additional evidence that cognitive assessment of stroke patients is important and their cognitive complaints should not be ignored.

Co-Director of the Centre for Healthy Brain Ageing, Professor Perminder Sachdev

The researchers also set out to determine the risk factors for cognitive decline after stroke.

The analysis, published in Stroke, included 1488 stroke patients with ischaemic stroke and a mean age of 66 years.

It included nine studies from STROKOG across seven countries, including Australia, Asia, Europe and the United States.

The patients were followed up for a median of three years.

“We discovered that the cognitive function of stroke survivors improves for a short period soon after a stroke and then decreases – beginning from around one-year poststroke,” Lo says.

“The decline in stroke patients was small, but faster than that of individuals without stroke, and those with a second stroke during follow up had a much faster rate of cognitive decline.” 

“We also found that the decline in older stroke patients, compared with younger stroke patients, happened more quickly.”

According to Lo, this research is significant because the results have implications for the design of clinical trials of therapies to prevent or slow poststroke cognitive decline, which should take into consideration the trajectory of initial improvement and subsequent decline in cognition after stroke.

“Our results could also help clinicians better understand and plan for the long-term needs of patients with stroke,” she says.

“The limitations of the study include the relatively short follow-up period in some studies that limited our estimation of the course of cognitive function to three years and individuals with poorer baseline cognitive function dropping out of the study.

Lo says the initial period of improvement was likely to have been the result of a combination of genuine recovery as well as practice effects, which means that participants may achieve higher test scores in the follow up assessments since they completed the same tests at least once prior.

“While it is out of scope to address this initial period of improvement in this paper, it is the focus of our next research.”

Co-Director of the Centre for Healthy Brain Ageing and co-author on the research, Professor Perminder Sachdev, says the research justified further research to develop strategies to decrease cognitive decline following stroke.

“The traditional focus in stroke rehabilitation has been on physical recovery and speech therapy, and cognitive function has been relatively neglected.

“This work provides additional evidence that cognitive assessment of stroke patients is important and their cognitive complaints should not be ignored,” Sachdev says.

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