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Cognitive performance following stroke, transient ischaemic attack, myocardial infarction, and hospitalisation: an individual participant data meta-analysis of six randomised controlled trials.
Sherlock, Laura; Lee, Shun Fu; Katsanos, Aristeidis H; Cukierman-Yaffe, Tali; Canavan, Michelle; Joundi, Raed; Sharma, Mukul; Shoamanesh, Ashkan; Brayne, Carol; Gerstein, Hertzel C; O'Donnell, Martin J; Muniz-Terrera, Graciela; Yusuf, Salim; Bosch, Jackie; Whiteley, William N.
Affiliation
  • Sherlock L; Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
  • Lee SF; Population Health Research Institute, Hamilton, ON, Canada.
  • Katsanos AH; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.
  • Cukierman-Yaffe T; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel; Division of Endocrinology and Metabolism, Sheba Medical Center, Ramat Gan, Israel.
  • Canavan M; HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland.
  • Joundi R; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.
  • Sharma M; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.
  • Shoamanesh A; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada.
  • Brayne C; Cambridge Public Health, University of Cambridge, Cambridge, UK.
  • Gerstein HC; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Neurology, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada.
  • O'Donnell MJ; Population Health Research Institute, Hamilton, ON, Canada; HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland; Department of Geriatric and Stroke Medicine, Galway University Hospital, Galway, Ireland.
  • Muniz-Terrera G; Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Department of Social Medicine, Ohio University, OH, USA.
  • Yusuf S; Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine-Cardiology, McMaster University, Hamilton, ON, Canada.
  • Bosch J; Population Health Research Institute, Hamilton, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
  • Whiteley WN; Population Health Research Institute, Hamilton, ON, Canada; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: william.whiteley@phri.ca.
Lancet Healthy Longev ; 4(12): e665-e674, 2023 12.
Article in En | MEDLINE | ID: mdl-38042159
ABSTRACT

BACKGROUND:

Survivors of stroke are often concerned about cognitive problems, and information on the risk of cognitive problems often comes from small studies. We aimed to estimate years of cognitive ageing associated with stroke compared with transient ischaemic attack, myocardial infarction, and other hospitalisations in a large population.

METHODS:

Using data from six randomised controlled trials (ORIGIN, ONTARGET, TRANSCEND, COMPASS, HOPE-3, and NAVIGATE ESUS), we completed an individual participant data meta-analysis using data requested from the Public Health Research Institute to estimate the association of stroke (by type and severity), transient ischaemic attack, myocardial infarction, and other hospitalisations with cognitive performance measured at the end of each trial. We included participants in any of these randomised controlled trials with a cognitive assessment at baseline and at least one other timepoint. Cognitive performance was measured with the Mini-Mental State Examination or the Montreal Cognitive Assessment, transformed into Z scores. We estimated Z score differences in end of trial cognitive performance between people with and without events and calculated corresponding years of cognitive ageing in these trials, and additionally calculated using a population representative cohort-the Cognitive Function and Ageing Study.

FINDINGS:

In 64 106 participants from 55 countries, compared with no event, stroke was associated with 18 years of cognitive ageing (1487 strokes included in the model, 95% CI 10 to 28; p<0·0001) and transient ischaemic attack with 3 years (660 transient ischaemic attacks included in the model, 0 to 6; p=0·021). Myocardial infarction (p=0·60) and other hospitalisations (p=0·26) were not associated with cognitive ageing. The mean difference in SD compared with people without an event was -0·84 (95% CI -0·91 to -0·76; p<0·0001) for disabling stroke, and -0·12 (-0·19 to -0·05; p=0·0012) for non-disabling stroke. Haemorrhagic stroke was associated with worse cognition (-0·75, -0·95 to -0·55; p<0·0001) than ischaemic stroke (-0·42, -0·48 to -0·36; p <0·0001).

INTERPRETATION:

Stroke has a substantial effect on cognition. The effects of transient ischaemic attack were small, whereas myocardial infarction and hospitalisation had a neutral effect. Prevention of stroke could lead to a reduction in cognitive ageing in those at greatest risk.

FUNDING:

Population Health Research Institute and Chief Scientist Office of Scotland.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Ischemia / Ischemic Attack, Transient / Stroke / Myocardial Infarction Type of study: Systematic_reviews Limits: Humans Language: En Journal: Lancet Healthy Longev Year: 2023 Document type: Article Affiliation country: United kingdom
Fulltext
Add to My VHL
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Ischemia / Ischemic Attack, Transient / Stroke / Myocardial Infarction Type of study: Systematic_reviews Limits: Humans Language: En Journal: Lancet Healthy Longev Year: 2023 Document type: Article Affiliation country: United kingdom