Longitudinal Effect of Stroke on Cognition: A Systematic Review

Eugene Yh Tang, Obreniokibo Amiesimaka, Stephanie L Harrison, Emma Green, Christopher Price, Louise Robinson, Mario Siervo, Blossom Cm Stephan, Eugene Yh Tang, Obreniokibo Amiesimaka, Stephanie L Harrison, Emma Green, Christopher Price, Louise Robinson, Mario Siervo, Blossom Cm Stephan

Abstract

Background: Stroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors.

Methods and results: Three electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow-up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed.

Conclusions: Stroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health-related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.

Keywords: cognition; cognitive impairment; dementia; risk factors/global assessment; stroke.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Flow diagram showing article selection. RCT indicates randomized controlled trial.

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