TY - JOUR
T1 - Short-term Trajectories of Poststroke Cognitive Function
T2 - A STROKOG Collaboration Study
AU - Lo, Jessica W.
AU - Crawford, John D.
AU - Desmond, David W.
AU - Bae, Hee Joon
AU - Lim, Jae Sung
AU - Godefroy, Olivier
AU - Roussel, Martine
AU - Köhler, Sebastian
AU - Staals, Julie
AU - Verhey, Frans
AU - Chen, Christopher
AU - Xu, Xin
AU - Chong, Eddie J.
AU - Kandiah, Nagaendran
AU - Bordet, Régis
AU - Dondaine, Thibaut
AU - Mendyk, Anne Marie
AU - Brodaty, Henry
AU - Traykov, Latchezar
AU - Mehrabian, Shima
AU - Petrova, Neli
AU - Lipnicki, Darren M.
AU - Lam, Ben Chun Pan
AU - Sachdev, Perminder S.
N1 - Funding Information:
This work was supported by the National Health and Medical Research Council of Australia (APP1161858; 2019-2021) and (RG203943; 2021-2026).
Publisher Copyright:
© American Academy of Neurology.
PY - 2023/6/6
Y1 - 2023/6/6
N2 - Background and ObjectivesPast studies on poststroke cognitive function have focused on the average performance or change over time, but few have investigated patterns of cognitive trajectories after stroke. This project used latent class growth analysis (LCGA) to identify clusters of patients with similar patterns of cognition scores over the first-year poststroke and the extent to which long-term cognitive outcome is predicted by the clusters ("trajectory groups").MethodsData were sought from the Stroke and Cognition consortium. LCGA was used to identify clusters of trajectories based on standardized global cognition scores at baseline (T1) and at the 1-year follow-up (T2). One-step individual participant data meta-analysis was used to examine risk factors for trajectory groups and association of trajectory groups with cognition at the long-term follow-up (T3).ResultsNine hospital-based stroke cohorts with 1,149 patients (63% male; mean age 66.4 years [SD 11.0]) were included. The median time assessed at T1 was 3.6 months poststroke, 1.0 year at T2, and 3.2 years at T3. LCGA identified 3 trajectory groups, which were characterized by different mean levels of cognition scores at T1 (low-performance, -3.27 SD [0.94], 17%; medium-performance, -1.23 SD [0.68], 48%; and high-performance, 0.71 SD [0.77], 35%). There was significant improvement in cognition for the high-performance group (0.22 SD per year, 95% CI 0.07-0.36), but changes for the low-performance and medium-performance groups were not significant (-0.10 SD per year, 95% CI -0.33 to 0.13; 0.11 SD per year, 95% CI -0.08 to 0.24, respectively). Factors associated with the low- (vs high-) performance group include age (relative risk ratio [RRR] 1.18, 95% CI 1.14-1.23), years of education (RRR 0.61, 95% CI 0.56-0.67), diabetes (RRR 3.78, 95% CI 2.08-6.88), large artery vs small vessel strokes (RRR 2.77, 95% CI 1.32-5.83), and moderate/severe strokes (RRR 3.17, 95% CI 1.42-7.08). Trajectory groups were predictive of global cognition at T3, but its predictive power was comparable with scores at T1.DiscussionThe trajectory of cognitive function over the first-year poststroke is heterogenous. Baseline cognitive function ~3.6 months poststroke is a good predictor of long-term cognitive outcome. Older age, lower levels of education, diabetes, large artery strokes, and greater stroke severity are risk factors for lower cognitive performance over the first year.
AB - Background and ObjectivesPast studies on poststroke cognitive function have focused on the average performance or change over time, but few have investigated patterns of cognitive trajectories after stroke. This project used latent class growth analysis (LCGA) to identify clusters of patients with similar patterns of cognition scores over the first-year poststroke and the extent to which long-term cognitive outcome is predicted by the clusters ("trajectory groups").MethodsData were sought from the Stroke and Cognition consortium. LCGA was used to identify clusters of trajectories based on standardized global cognition scores at baseline (T1) and at the 1-year follow-up (T2). One-step individual participant data meta-analysis was used to examine risk factors for trajectory groups and association of trajectory groups with cognition at the long-term follow-up (T3).ResultsNine hospital-based stroke cohorts with 1,149 patients (63% male; mean age 66.4 years [SD 11.0]) were included. The median time assessed at T1 was 3.6 months poststroke, 1.0 year at T2, and 3.2 years at T3. LCGA identified 3 trajectory groups, which were characterized by different mean levels of cognition scores at T1 (low-performance, -3.27 SD [0.94], 17%; medium-performance, -1.23 SD [0.68], 48%; and high-performance, 0.71 SD [0.77], 35%). There was significant improvement in cognition for the high-performance group (0.22 SD per year, 95% CI 0.07-0.36), but changes for the low-performance and medium-performance groups were not significant (-0.10 SD per year, 95% CI -0.33 to 0.13; 0.11 SD per year, 95% CI -0.08 to 0.24, respectively). Factors associated with the low- (vs high-) performance group include age (relative risk ratio [RRR] 1.18, 95% CI 1.14-1.23), years of education (RRR 0.61, 95% CI 0.56-0.67), diabetes (RRR 3.78, 95% CI 2.08-6.88), large artery vs small vessel strokes (RRR 2.77, 95% CI 1.32-5.83), and moderate/severe strokes (RRR 3.17, 95% CI 1.42-7.08). Trajectory groups were predictive of global cognition at T3, but its predictive power was comparable with scores at T1.DiscussionThe trajectory of cognitive function over the first-year poststroke is heterogenous. Baseline cognitive function ~3.6 months poststroke is a good predictor of long-term cognitive outcome. Older age, lower levels of education, diabetes, large artery strokes, and greater stroke severity are risk factors for lower cognitive performance over the first year.
UR - http://www.scopus.com/inward/record.url?scp=85162099608&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000207281
DO - 10.1212/WNL.0000000000207281
M3 - Article
C2 - 37072222
SN - 0028-3878
VL - 100
SP - E2331-E2341
JO - Neurology
JF - Neurology
IS - 23
ER -