Short-term Trajectories of Poststroke Cognitive Function
A STROKOG Collaboration Study
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Abstract
Background and Objectives Past 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”).
Methods Data 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).
Results Nine 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.
Discussion The 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.
Glossary
- AIC=
- Akaike information criterion;
- ALCPP=
- average latent class posterior probability;
- BIC=
- Bayesian information criterion;
- IQR=
- interquartile range;
- LCGA=
- latent class growth analysis;
- STROKOG=
- Stroke and Cognition consortium
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed in Appendix 2 at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
- Received May 17, 2022.
- Accepted in final form February 27, 2023.
- © 2023 American Academy of Neurology
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