Long-term trajectories of cognitive and daily function decline before and after stroke Free

Heshmatollah A, Dommershuijsen LJ, Fani L, et al. Long-term trajectories of cognitive and daily function decline before and after strokeJournal of Neurology, Neurosurgery & Psychiatry First published online: July 6, 2021. doi : 10.1136 / jnnp-2021-326043

Commentary

The fact that cognitive decline occurs after stroke is becoming well known. Little is known about pre-stroke and the potential for functional decline, making this study the first to determine the long-term trajectory of cognition and daily functioning before and after stroke.

We repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-word learning, letter-number substitution, Stroop, verbal fluency, and Perdue pegboard) and activities of daily living (BADL and IADL) from 1990-2016. 

One hundred and forty-two participants from the population-based Rotterdam study were included, and incident strokes were assessed by continuous monitoring of medical records through 2018.

As a result, a total of 1662 participants had a stroke during a mean follow-up of 12.5±6.8 years. Significant pre-stroke deviations were seen in the MMSE (6.4 years), Stroop (5.7 years), Perdue Pegboard (3.8 years), BADL and IADL (2.2 years and 3.0 years, respectively), cognitive, and daily functioning deviating from stroke-free controls up to 10 years prior to diagnosis. The results are shown in the following scores.

In conclusion, patients who have had a stroke show a more rapid decline in cognition and daily functioning by 10 years before first onset compared to patients who have not had a stroke.