Age differences in the change in cognition after stroke

Mellanie V Springer; Bingxin Chen; Rachael T Whitney; Emily M Briceño; Alden L Gross; Hugo J Aparicio; Alexa S Beiser; James F Burke; Bruno Giordani; Rebecca F Gottesman; Rodney A Hayward; Virginia J Howard; Silvia Koton; Ronald M Lazar; Jeremy B Sussman; Wen Ye; Deborah A Levine

doi:10.1016/j.jstrokecerebrovasdis.2024.108087

Age differences in the change in cognition after stroke

J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108087. doi: 10.1016/j.jstrokecerebrovasdis.2024.108087. Epub 2024 Oct 12.

Authors

Mellanie V Springer¹, Bingxin Chen², Rachael T Whitney³, Emily M Briceño⁴, Alden L Gross⁵, Hugo J Aparicio⁶, Alexa S Beiser⁷, James F Burke⁸, Bruno Giordani⁹, Rebecca F Gottesman¹⁰, Rodney A Hayward¹¹, Virginia J Howard¹², Silvia Koton¹³, Ronald M Lazar¹⁴, Jeremy B Sussman¹¹, Wen Ye¹⁵, Deborah A Levine¹⁶

Affiliations

¹ 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. Electronic address: mvsprin@med.umich.edu.
² Department of Nursing, University of Michigan, Ann Arbor, MI, USA.
³ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, MD, USA.
⁶ Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, USA.
⁷ Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
⁸ Department of Neurology, Ohio State University College of Medicine, Columbus, OH, USA.
⁹ Department of Psychiatry and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
¹¹ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
¹² Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
¹³ Department of Epidemiology, Johns Hopkins Bloomberg School Public Health, Baltimore, MD, USA; Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel.
¹⁴ Department of Neurology and Evelyn F. McKnight Brain Institute, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁵ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
¹⁶ 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 Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.

PMID: 39401577
PMCID: PMC11906114 (available on 2025-12-01)
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108087

Abstract

Objective: To compare changes in cognitive trajectories after stroke between younger (18-64) and older (65+) adults, accounting for pre-stroke cognitive trajectories.

Materials and methods: 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.

Results: 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.

Conclusion: Older age was associated with greater post-stroke cognitive declines, accounting for differences in pre-stroke cognitive trajectories between the old and the young.

Keywords: Aging; Cognition; Cognitive decline; Hemorrhagic stroke; Ischemic stroke; Stroke.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cognition*
Cognitive Dysfunction / diagnosis
Cognitive Dysfunction / epidemiology
Cognitive Dysfunction / etiology
Cognitive Dysfunction / physiopathology
Cognitive Dysfunction / psychology
Disease Progression
Executive Function*
Female
Humans
Male
Memory*
Middle Aged
Prognosis
Risk Assessment
Risk Factors
Stroke* / complications
Stroke* / diagnosis
Stroke* / physiopathology
Stroke* / psychology
Time Factors
United States / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

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