Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Nursing, University of Michigan, Ann Arbor, MI, USA.
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108087. doi: 10.1016/j.jstrokecerebrovasdis.2024.108087. Epub 2024 Oct 12.
To compare changes in cognitive trajectories after stroke between younger (18-64) and older (65+) adults, accounting for pre-stroke cognitive trajectories.
Pooled cohort study using individual participant data from 3 US cohorts (1971-2019), the Atherosclerosis Risk In Communities Study (ARIC), Framingham Offspring Study (FOS), and REasons for Geographic And Racial Differences in Stroke Study (REGARDS). Linear mixed effect models evaluated the association between age and the initial change (intercept) and rate of change (slope) in cognition after compared to before stroke. Outcomes were global cognition (primary), memory and executive function.
We included 1,292 participants with stroke; 197 younger (47.2 % female, 32.5 % Black race) and 1,095 older (50.2 % female, 46.4 % Black race). Median (IQR) age at stroke was 59.7 (56.6-61.7) (younger group) and 75.2 (70.5-80.2) years (older group). Compared to the young, older participants had greater declines in global cognition (-1.69 point [95 % CI, -2.82 to -0.55] greater), memory (-1.05 point [95 % CI, -1.92 to -0.17] greater), and executive function (-3.72 point [95 % CI, -5.23 to -2.21] greater) initially after stroke. Older age was associated with faster declines in global cognition (-0.18 points per year [95 % CI, -0.36 to -0.01] faster) and executive function (-0.16 [95 % CI, -0.26 to -0.06] points per year for every 10 years of higher age), but not memory (-0.006 [95 % CI, -0.15 to 0.14]), after compared to before stroke.
Older age was associated with greater post-stroke cognitive declines, accounting for differences in pre-stroke cognitive trajectories between the old and the young.
比较年轻（18-64 岁）和老年（65 岁以上）卒中患者的认知轨迹变化，同时考虑到卒中前的认知轨迹。
本研究为使用来自美国 3 个队列（1971-2019 年）的个体参与者数据进行的汇总队列研究，这些队列包括动脉粥样硬化风险社区研究（ARIC）、弗雷明汉后代研究（FOS）和地理与种族差异导致卒中研究（REGARDS）。线性混合效应模型评估了年龄与卒中前后认知初始变化（截距）和变化率（斜率）之间的关系。结局为总体认知（主要结局）、记忆和执行功能。
共纳入 1292 例卒中患者；197 例为年轻患者（47.2%为女性，32.5%为黑人），1095 例为老年患者（50.2%为女性，46.4%为黑人）。卒中时的中位（IQR）年龄为 59.7（56.6-61.7）岁（年轻组）和 75.2（70.5-80.2）岁（老年组）。与年轻患者相比，老年患者在卒中后认知总体水平（-1.69 点[95%CI，-2.82 至 -0.55]下降更明显）、记忆（-1.05 点[95%CI，-1.92 至 -0.17]下降更明显）和执行功能（-3.72 点[95%CI，-5.23 至 -2.21]下降更明显）初始时下降幅度更大。与卒中前相比，老年患者在卒中后认知总体水平（每年下降 0.18 点[95%CI，-0.36 至 -0.01]下降更快）和执行功能（每年下降 0.16 点[95%CI，-0.26 至 -0.06]下降更快）下降更快，但记忆（每年下降 0.006 点[95%CI，-0.15 至 0.14]）下降速度无差异。
与年轻患者相比，老年患者卒中后认知能力下降幅度更大，这与老年和年轻患者卒中前的认知轨迹差异有关。
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