Domain-Specific Cognitive Trajectories Among Patients with Minor Stroke or Transient Ischemic Attack in a 6-Year Prospective Asian Cohort: Serial Patterns and Indicators

Article type: Research Article

Authors: Zhao, Xuhao^a | Chong, Eddie Jun Yi^b | Qi, Wei^a | Pang, Ting^a | Xu, Xin^{a; c; *} | Chen, Christopher^{b; c}

Affiliations: [a] School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, China | [b] Memory, Ageing and Cognition Centre (MACC), Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore | [c] Memory, Ageing and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Correspondence: [*] Correspondence to: Xu Xin, PhD, School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, 310000, China. E-mail: [email protected].

Abstract: Background:Long-term post-stroke cognitive impairment (PSCI) has often been overlooked, especially among patients with minor stroke or transient ischemic attack (TIA). Objective:To assess 6-year domain-specific cognitive trajectories among survivors of minor stroke or TIA and to identify possible indicators associated with cognitive trajectories, as well as long-term and incident PSCI. Methods:Eligible participants completed cognitive and clinical assessments at baseline (2 weeks after stroke) and up to 5 follow-up visits in 6 years. Mixed linear models and generalized estimating equations were adopted to analyze longitudinal data and survival analysis to explore incident PSCI, controlling for demographic, clinical, and vascular indicators. Results:The prevalence of PSCI and mortality rate ranged from 34.6% to 53.7%, and 0 to 7.7% respectively, among 244 patients. Incidence of PSCI was 21.9%. While visual memory demonstrated a significant improvement (p < 0.05), other cognitive domains showed a fluctuating yet stable pattern across visits (all ps > 0.05). Besides age, baseline IQCODE (attention: –0.218 SD/y, executive function: –0.238 SD/y, visual memory: –0.266 SD/y), and MoCA improvement within 1 year (visuoconstruction: 0.007 SD/y, verbal memory: 0.012 SD/y) were associated with longitudinal cognitive changes. Baseline MoCA (OR = 0.66, 95% CI = [0.59–0.74]), MoCA improvement within 3–6 months (OR = 0.79, 95% CI = [0.71–0.89], and within 1 year (OR = 0.86, 95% CI = [0.76–0.96]) were associated with long-term PSCI, while baseline MoCA (OR = 0.76, 95% CI = [0.61–0.96]) was also associated with incident PSCI. Conclusion:While most domains remained stable across-time, visual memory demonstrated an overall improvement. Short-term cognitive improvement could be an early indicator of long-term cognitive trajectory to identify individuals who may be resilient to PSCI.

Keywords: Cognitive impairment, cognitive trajectory, domain-specific cognition, minor stroke, risk factor, transient ischemic attack

DOI: 10.3233/JAD-210619

Journal: Journal of Alzheimer's Disease, vol. 83, no. 2, pp. 557-568, 2021